Stoic and Buddhist Cognitive Behavioural Therapy by Patrick Ussher

The following is a modified extract from Patrick Ussher’s recent e-book Stoicism & Western Buddhism: A Reflection on Two Philosophies as a Way of Life.  Patrick is the founding editor of Stoicism Today, and one of the original members of the Modern Stoicism Team.
‘Stay with me a little while, sense-impression (phantasia). Allow me to see who you are and from where you come. Allow me to examine you.’- Epictetus [1]
‘Breathing in / I know that an unpleasant feeling has just arisen in me…Breathing out/ I can see the roots of this unpleasant feeling.’[2]
‘Hello, Fear. There you are again.’- Thich Nhat Hanh [3]
Both Stoicism and Buddhism encourage a healthy sense of doubt towards the thoughts and emotions we have each and every day. The aim of this doubt is to encourage us to take a step back when we have certain thoughts or feelings, examine them, and come up with a ‘wise response’ to them.
One such ‘wise response’ is simply to ensure that we have an accurate conception of what has occurred, and that we are not ‘clouded’ by, for example, erroneous thinking or overwhelming emotions. For, it is not, as Epictetus says, ‘…the things themselves that disturb men, but their judgements about these things’,[4] a psychological basis echoed by Thich Nhat Hanh, a leading contemporary Buddhist teacher, when he writes that ‘…wrong perceptions cause incorrect thinking and unnecessary suffering,’[5] encouraging his students instead to ask themselves continuously, ‘are you sure?’[6]
This focus on maintaining accuracy in our thoughts and emotions might seem rather similar to Cognitive Behavioural Therapy (C.B.T.), a therapy designed for the removal of harmful beliefs which lead to, and perpetuate, various mental health problems, including anxiety disorders. C.B.T. in particular focuses on how accurate our thoughts and feelings may be.
Indeed, Stoicism and Buddhism are often regarded as being akin to C.B.T. in that both philosophies engage in actively replacing thoughts and behaviours, and, in that sense, both philosophies are, in a sense, forms of cognitive and behavioural therapy in their own right. Furthermore, it has been argued that both philosophies influenced the development of C.B.T. In the case of Stoicism, Albert Ellis, the founder of C.B.T., cited Epictetus and Marcus Aurelius as some of his main inspirations,[7] and Donald Robertson, a member of the Modern Stoicism project, has written a book on the Stoic origins of C.B.T.[8]
Meanwhile, in the case of Buddhism, Albert Ellis also cited the Buddha as one of his inspirations and, interestingly, Jack Kornfield considers that Buddhists were the ‘…first cognitive-behavioural therapists.’ [9] He cites the Buddha’s words from the Vitakkasanthana Sutta (Discourse on Removing Distracting Thoughts) from the Majhima Nikaya (The Middle Length Discourses) in support of this:

There is the case where evil, unskilful thoughts – imbued with desire, aversion, or delusion arise…(and then) he (the monk) should attend to another theme, apart from that one, connected with what is skilful….just as a skilled carpenter or his apprentice would use a small peg to knock out, drive out and pull out a large one…[10]

Such a ‘thought-replacement’ exercise is clearly a kind of cognitive therapy and we find something very similar in Stoicism with its emphasis on replacing ‘initial thoughts’ we have with wiser and more virtuous thoughts. However, while these general similarities do exist, it is very important, in my view, to separate both Buddhism and Stoicism from the more ‘clinical’ and overly rationalistic nature of C.B.T., even though there may be some similarities. For ultimately, Stoicism and Buddhism are philosophies which seek to offer coherent frameworks for life as a whole, something which C.B.T. does not, and cannot ever, do. C.B.T. focuses on removing specific problems, and it can be very helpful with this, but does not offer a ‘bigger picture’ approach for understanding life and how to live in general.
Let us consider instead the nature of Stoic and Buddhist behaviourism in their own right. If we were to categorise Buddhism or Stoicism as a form of C.B.T., how would we describe them? And what kind of practices in daily life would these philosophies encourage?

Buddhist “Behaviourism With Heart”

In the case of Buddhism, Jack Kornfield, a leading teacher of ‘Western Buddhism’, terms Buddhism’s equivalent to C.B.T. as ‘Behaviourism with Heart,’[11] writing that one changes thoughts out of compassion for oneself and others,[12] and that this is what is in ‘…our genuine interest,’[13] thereby divorcing the practice from a more clinical-therapeutic context. Rather than purely changing thoughts or emotions in order to make them more ‘accurate’, the Buddhist is also interested in cultivating a heart-felt response to our emotions and to those of others. Compassion is the ‘reference point’ to which the Buddhist so often refers in working with her thoughts and emotions. When we have feelings, particularly ones that we might otherwise try to avoid, the Buddhist instead aims to accept them, with a gentle and understanding love, and, in general, the Buddhist seeks solutions to larger life problems by considering them in the most compassionate light possible.
This encapsulates the heart of a Buddhist’s daily practice. The focus is on using mindfulness to accept the emotional flow of the day with a gentle love. This compassionate awareness allows the self to change gradually.

Stoic ‘Behaviourism Towards Virtue’

But what would the equivalent be in Stoicism? I would suggest that the Stoic equivalent is ‘Behaviourism towards Virtue’. By this I mean that the Stoic tries continuously to work out how to reframe their emotions and thoughts in light of virtue, which, according to Stoicism, is the most important thing in life.
Let us consider the following passage from Marcus Aurelius which essentially captures how this process works:

 …always make a sketch or plan of whatever presents itself to your mind, so as to see what sort of thing it is when stripped down to its essence, as a whole and in its separate parts; and tell yourself its proper name, and the names of the elements from which it has been put together and into which it will finally be resolved. For nothing is as effective in creating greatness of mind as being able to examine methodically and truthfully everything that presents itself in life, and always viewing things in such a way as to consider what kind of use each thing serves in what kind of universe, and what value it has to human beings as citizens of the highest of cities…and what this object is that presently makes an impression on me, and what it is composed of, and how long it will naturally persist, and what virtue is needed in the face of it, such as gentleness, courage, truthfulness, good faith, simplicity, self-sufficiency, and so forth.[14]

What Marcus suggests here is the cultivation of clear awareness of thoughts, and this involves taking a step back so as to delineate clearly what is on one’s mind. Marcus then tries to discern what place these thoughts and feelings might have in relation to his own ethical beliefs about what is most important in life. What kind of value-judgements are ‘packed into’ these impressions and are they ethically helpful? Then, he wishes to work out which ethical qualities will be of most help in approaching the situation to which the impressions relate: will it, for example, be gentleness, courage, or simplicity? This in particular is the point at which the Stoic tries to work out the ‘virtuous response’ to the impressions under consideration. Indeed, the entire purpose of the exercise is one of increasing ethical awareness. As Chris Gill, a scholar on Stoicism, writes of this passage:

Although this may seem at first to be a purely scientific or analytical procedure, what Marcus has in mind is getting to the ethical core of the situation.[15] 

By following these steps, Marcus takes the thoughts and feelings that arise in his mind and reframes them in the light of Stoic virtue. And, then, once he acts based upon his ‘virtuous response’, he will have successfully modified his behaviour ‘towards virtue’.
How can we sum up both approaches in the light of the C.B.T. analogy? The Buddhist continually moulds himself towards the compassionate mind. Indeed, Thich Nhat Hanh explains that the Chinese character for ‘mindfulness’ contains the signs for both ‘now’ and ‘heart.’[16] The Stoic, in contrast, consistently strives to mould her character towards virtue. If Stoic ‘prosoche/mindfulness’ had a Chinese character, it would probably be the signs for ‘now’ and ‘virtue’.
And if we were to seek to combine both kinds of mindfulness, the one which gives us an ethical compass by which to guide our life’s direction and the other to accompany us on that journey with heartfelt compassion, then we would be doing very well indeed.
[1] Discourses, 2.18.24.
[2] 2006a, 58ff. Text modified [original = ‘pleasant’ feeling, but this method is applicable to all feelings].
[3] 1995, 66.
[4] Handbook §5..
[5] 1998, 61.
[6] 1998, 60-61.
[7] In an interview with J. Evans (http://philosophyforlife.org/albert-ellis-on-philosophy-as-therapy/)
[8] The Philosophy of CBT: Stoic Philosophy as Rational and Cognitive Psychotherapy, Karnac, 2010.
[9] 2008, 293.
[10] Majhima Nikaya, I.119.
[11] Kornfield (2008), 293.
[12] Kornfield (2008), 296
[13] Kornfield (2008), 299.
[14] Meditations, 3.11.
[15] 2011, xvii.
[16] 1998, 64f.
Patrick Ussher is a PhD student at the University of Exeter, working on Stoic ideas of ethical development. His MA dissertation compared Stoicism and ‘Western’ Buddhism. He managed the Stoicism Today blog from its inception in 2012 until March 2016 when he left the Modern Stoicism project to focus on other work commitments. He also edited the first two collections of writings of applying Stoicism to the modern world, Stoicism Today: Selected Writings volume 1, and volume 2.