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 Review53, 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

Author: Gregory Sadler

Editor of Stoicism Today, president of ReasonIO, adjunct professor at Milwaukee Institute of Art and Design | Sadler's Lectures podcast - https://soundcloud.com/gregorybsadler | YouTube channel with 1700+ philosophy videos - https://www.youtube.com/c/GregoryBSadler

4 thoughts on “Investigating the Impact of Stoicism For Those At Risk of Anxiety and Depression – Findings and Reflections by Alexander MacLellan”

  1. Hi Tim,

    At the minute I don’t think it would be right to say that Stoicism offers anything above and beyond CBT yet, simply because we are at the start of the journey and it requires much more examination. My inclination is that introducing people to Stoic ideas and principles might supplement CBT or other talking therapies. I’d feel more content saying this if the findings showing reduced rumination and increased self-efficacy are replicated in future studies, as these have both been linked as predictors of success of courses of CBT. That’s just from this one study though, and who knows what interesting patterns may emerge in the future. Taking off the hat of caution and purely giving my opinion, I think that broadening access to Stoicism and other philosophies is a viable way forward in reaching and helping those who don’t want to go forward with therapy either for fear of stigma, who are highly isolated and unable to access services or who dislike aspects of CBT.

    Thanks for the comment and reading!

    Best,
    Alex

  2. Great work, Alex, and a very useful summary. What do you think we can say at the moment to the CBT (Cognitive Behavioural Therapy) community? As a therapist, I will draw on Stoicism when it seems helpful, but are we in a position yet where we can say that Stoicism offers anything over and above what CBT therapists might otherwise do?

    1. I’m not the author, nor am I a therapist, so please take this with a grain of salt.

      Stoics’ practice of the “dichotomy of control” and CBT as I understand it are fairly similar. I think Stoicism offers more than CBT through its variety of other practices. From the practices of Amor Fati and Premediatio Malorum, we have practices to not just react to circumstances around us and consider them rationally, but we can also truly embrace those moments in our lives as they come, and even prepare for those dispreferred ones.

      Then there are the virtues and principles like cosmopolitanism central to Stoicism that can help productively introduce patients to things like honesty and rationality and empathy without the need for religion or other forms of proselytizing to do so.

      That said, maybe I’m thinking of CBT in too limited a lens. But to me, it doesn’t require much virtue to practice. Maybe a little wisdom.

    2. Hi Tim,

      I’m not sure we can say anything apart from ‘watch this space -exciting potential’ yet, simply because we are at the beginning of the journey, and saying anything else in a formalised manner wouldn’t be appropriate. I think that if we can replicate these results around rumination and self-efficacy, and find some good behavioural effects as well, there will come a time where Stoicism is a potential supporter of talking therapies (especially as rumination and self-efficacy have been proposed as predictors of success from courses of CBT). In my opinion, I would love to see philosophies like Stoicism used as a way to reach those who are isolated from talking therapy, either by a fear of a stigma, issues around cost/accessibility, or simply by those who do not like or for whom CBT does not work. I hope that answers your question!

      Best,
      Alex

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