Investigating the Impact of Stoicism For Those At Risk of Anxiety and Depression – Findings and Reflections by Alexander MacLellan

On the 1st of January this year, my study [1] investigating the effects of practicing Stoicism in a sample of high worriers was published in Cognitive Therapy and Research, a well known academic journal in the field of psychology. It is, at present and to my current knowledge, the first study of its kind, and (I hope) the first of many to come. I am writing this post to share the results from this study in a somewhat more accessible form to an audience of people who are here for the philosophy rather than the psychology. For those who want to read it first or dig down into anything about the study, the paper is currently available to read here.

This whole process has also given me much to think about and reflect on and hopefully this can create some discussion points amongst those hoping to engage with and grow the modern Stoicism community.

Attentional Control Theory [2] is what underpins this study. This theory states that anxiety (though more recently, depression and other emotional dysregulation disorders are linked with this theory too) is maintained by inefficiencies in attentional control. Due to a variety of factors, the brain is no longer able to effectively balance unconscious emotional signals in response to stimuli with more rational, goal-directed signals. This means that people with anxiety, depression etc. are less able to ignore distracting stimuli (including internal stimuli like negative thoughts), less able to disengage from them, and therefore less able to remain task-focussed.

There has been much research resulting in findings that cognitive control trainings can improve anxious and depressed symptomatology by strengthening this attentional control system [3][4].

The question then raised by this is twofold: 1) Can Stoic practices and ideas help those who are at risk of anxiety and depression; and 2) If someone becomes more ‘Stoic’ does this also mean their cognitive control improves?

The Study

The study discussed here was a randomised controlled trial type study. I say “type”, as it was not on a sufficient scale to be accurately called a randomised controlled trial in the full sense. Nevertheless, it had some very important features, namely that participants were recruited from a multitude of sources and were, to my knowledge, not practising Stoics. There would be, therefore, less chance of a desire to prove Stoicism works biasing the study.

Participants were randomly allocated to either an active control group, a group combining Stoic Training (described below) and a well known cognitive control training. The cognitive control training is known as the adaptive dual n-back task, and involves participants continuously monitoring two streams of information (audio and visual), and having to correctly identify if the stimulus currently presented to them matches what was presented a certain number of trials back.

The Stoic training itself is something that you’ll likely recognise. It would not have been possible without speaking with Donald Robertson and Tim LeBon, and so it looked very much like a Stoic Week platform. Each day participants were given several readings and then asked to complete some exercises that are ostensibly considered to be “Stoic”. These included:

• listing any unhelpful judgements that day, and trying to recall and recreate how they came to be
• predicting any difficulties they might face that day, and how they might deal with them
• and, a daily summary of things they feel they did well, didn’t do well and didn’t do.

These exercises are all derived from the writings or suggestions of well known Stoics (namely Marcus Aurelius and Seneca). The daily reading selections are largely drawn from the works of classical Stoics. Participants completed 8 sessions of training and completed measures of anxiety, emotional vulnerability, self-efficacy, rumination and attentional control pre- and post-training.

Results and Interpretation

What we found was experimental groups had reductions in rumination by 18% and 13% respectively compared to the control group. Rumination is the tendency to linger on sad, depressive or hopeless thoughts, and is one of the biggest predictors of future onset of depression.

The group who completed the Stoic training also showed a 15% increase in self-efficacy, a factor known to engage positive coping in response to stress. This was in addition to some minor text analyses showing that over the training period, the language and statements participants used in their journaling became less anxious and negatively valenced (as measured by a content analysis software [5].

We also found correlations between an increase in Stoic thinking (as measured by a version of Tim LeBon’s Stoic Attitudes and Behaviours Scale) and positive emotional experience. This is in addition to a decrease in negative emotional experience and an increase in self-efficacy.

This has several interesting implications. It shows that you can augment one type of cognitive training by supplementing it with a second type in order to target different cognitive processes (though this is fairly accepted at this point).

But these results also demonstrate that Stoic principles might objectively be a good thing. Decreased rumination and increased self efficacy is a promising sign in people who might be emotionally vulnerable, being a risk factor and protective factor respectively. The correlation between Stoic thinking and emotional resilience (as measured by one scale) is also encouraging.

There were no significant findings with regards to attentional control and anxious symptomatology, yet some results bordered on significance.

Problems and Issues

There are quite a few problems with the study though. The sample size was quite small. We also didn’t see much in the way of behavioural effects (nothing that would be responsible to report with such a small sample size). In addition, engagement was patchy, and people were taking part entirely online, meaning there was much out of our experimental control.

As a Stoic, you can accept what is out of your control, but it makes scientific enquiry difficult, and makes findings harder to stand behind. Someone might feel or respond in a very different way if they are in a different room, taking the test at a different time of day or if there is the business of life at home in the background; whereas there aren’t those problems in a lab. We also did not delve into the connections between Stoic thinking and cognitive control beyond seeing a non-significant link, and this is something that must (and will) be rectified in the future.

That’s not to mention the problem with attempting to classify and study the effectiveness of a philosophy. There is too much to operationalise, and as academia is an intensely conservative domain, an attempt to try something new or untested needing to be justified to the nth degree. (A bugbear I have in my short time writing proposals is the preference to examine minutiae of something relatively well established rather than look at something new – though it is completely understandable).

Psychology and philosophy were two related fields and are natural partners, however they are far from reconciliation at the moment. Whilst I can theorise and put forwards my own thoughts as to why this is (as I have done on my podcast) I believe that for Stoicism to be better researched and potentially be of more use to more people, those who keep the proverbial gates of the community need to relax the rules of entry.

Maybe there can be levels of Stoicism. Perhaps the philosophy can be moved forwards and advanced. Perhaps we can admit that something can be, or contribute to, Stoicism even if it wasn’t originally written in Latin or Greek. Equally, those in academic psychology might want to be more willing to change tack or entertain different ideas for advancing mental health research. With alarming studies coming out now suggesting that the last 50 years of research into therapies has, in actuality, brought us no closer to something that works reliably[6], I’d argue that this would be worthwhile.

This study shows, in a small way, that reading and applying Stoic principles can help people who seem to be vulnerable to developing anxiety or depression. It also shows that it is possible to do this research. That it is worth pursuing. That questioning is never a bad thing.

If you are studying psychology, or social sciences, or perhaps are an established academic I’d ask you to consider studying Stoicism in more settings, in more ways. I’d like to see all philosophies get looked at, for more ideas to be brought forward and debated. Stoicism and the principles derived from it are by no means accepted or liked by many people in either of the fields of psychology or philosophy. There is a skepticism about philosophical systems that echo the structure of religions (I’ll leave it for better philosophers than I to point out what may be correct or incorrect in that statement). But with more research, more publications, it is my hope that philosophy books can come to be prescribed and recommended as freely as therapy or medication.

If you enjoyed this post and have any questions/topic suggestions, or if you hated it/want to tell me why I am wrong, feel free to email me. I’d be very pleased to hear from you!

References:

1. MacLellan & Derakshan (2021). The Effects of Stoic Training and Adaptive Working Memory Training on Emotional Vulnerability in High Worriers. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-020-10183-4
2. Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: attentional control theory. Emotion, 7(2), 336. doi: https://doi.org/10.1037/1528- 3542.7.2.336
3. Berggren, N., & Derakshan, N. (2013). Attentional control deficits in trait anxiety: why you see them and why you don’t. Biological Psychology, 92(3), 440-446. doi: https://doi.org/10.1016/j.biopsycho.2012.03.007
4. Koster, E. H., Hoorelbeke, K., Onraedt, T., Owens, M., & Derakshan, N. (2017). Cognitive control interventions for depression: A systematic review of findings from training studies. Clinical Psychology Review, 53, 79-92. https://doi.org/10.1016/j.cpr.2017.02.002
5. Pennebaker, J. W., Francis, M. E., & Booth, R. J. (2001). Linguistic inquiry and word count: LIWC 2001. Mahway: Lawrence Erlbaum Associates, 71. Last accessed online: http://liwc.wpengine.com/ on 12/01/2021
6. Cuijpers, P., Reijnders, M., & Huibers, M. J. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15, 207-231. https://doi.org/10.1146/annurev-clinpsy-050718-095424

Alex MacLellan is a psychologist starting his PhD work, focussing on the neural mechanisms of anxiety and depression with a special focus on philosophies and workplace wellbeing. He hosts The Stoic Psychology Podcast; and occasionally blogs at The Stoic Psychologist