Stoic Philosophy as Rational and Cognitive Psychotherapy

Donald Robertson

Publisher: Karnac Books (Aug 2010)
ISBN-10: 1855757567 / ISBN-13: 978-1855757561

The Philosophy of CBT

The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, published by Karnac and available for pre-order online now.

You can also now order The Philosophy of Cognitive-Behavioural Therapy from Amazon, where you may preview a sample of the contents online free of charge. See Donald’s author page on Amazon UK for additional publications.

You can now browse sample chapters from The Philosophy of CBT on Google Books free-of-charge.

Synopsis:

Why should modern psychotherapists be interested in philosophy, especially ancient philosophy? Why should philosophers be interested in psychotherapy? There is a sense of mutual attraction between what are today two thoroughly distinct disciplines. However, arguably it was not always the case that they were distinct.

Donald Robertson takes the view that by reconsidering the generally received wisdom concerning the history of these closely-related subjects, we can learn a great deal about both philosophy and psychotherapy, under which heading he includes potentially solitary pursuits such as “self-help” and “personal development”.

Testimonials:

Here are a selection of comments about The Philosophy of CBT from other therapy and philosophy authors:

[F]or many of us something is missing from most of the [CBT] literature. What has been needed is a book that covers the underlying philosophy of the cognitive behavioural therapies in much greater depth. This book on the Philosophy of Cognitive-Behavioural Therapy by Donald Robertson provides us with the missing link between the theory and the philosophy. [...] It is a fascinating read. The Philosophy of Cognitive-Behavioural Therapy could be considered as either a prequel or a sequel to the standard textbook read by a trainee or experienced cognitive behavioural or rational emotive practitioner who wants to understand these approaches to therapy within an historical framework.
— From the Foreword by Professor Stephen Palmer PhD FAREBT FBACP, Director of the Centre for Stress Management, London, UK

This book is a fascinating interweaving of Stoic philosophy and contemporary cognitive-behavioural therapy (CBT). Robertson rightly reminds us of how much CBT owes its philosophical origins to the Stoics but, sadly, how often this debt is insufficiently acknowledged. He urges us to redirect our attention to the past to see how modern CBT still has much to learn from its ancient precursors. Highly recommended.
— Michael Neenan, Co-Director of the CBT Programme, Centre for Stress Management, Bromley, Kent, UK

The author has uncovered a wealth of connections between modern cognitive-behavioural therapies and ancient Stoic philosophy. It should be read by anyone interested in understanding the historical roots of CBT or in learning about how ancient psychotherapeutic methods can add to the modern therapist’s toolkit.
— Tim LeBon, UKCP registered psychotherapist and author of Wise Therapy

Donald Robertson is blazing a trail to discover the sources of cognitive-behavioural therapy, and Stoic philosophy is prime among these. A fascinating work that should be compulsory reading for all practitioners in the field and interested lay people, providing insights into how ancient philosophy can give us the coping and life success strategies we are all looking for, both as professionals and in private life. A great read!
— Tom Butler-Bowdon, author of 50 Self-Help Classics and 50 Psychology Classics

Ancient Ethics in Hypnotherapy & Psychotherapy

Hippocrates of Kos

Copyright (c) Donald Robertson, 2010.  All rights reserved.

The Hippocratic Oath is an oath traditionally taken by doctors, and believed to have been written in the 4th century BC by Hippocrates, widely regarded as the father of Western medicine.  This is a traditional translation of the oath,

I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art –if they desire to learn it– without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.

I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

The oath has frequently been modified and modernised throughout recent centuries.  This is my proposal for a modern version adapted for hypnotherapy and psychotherapy,

I pledge a moral oath before my peers and colleagues, making them my witnesses, that I will fulfil to the best of my ability and judgement this covenant and undertaking,

I will respect the clinicians and researchers in my field, study their work diligently, critically, and with care, and extend their contributions by my own efforts to advance the therapeutic art and science.

I will apply therapeutic methods for the benefit of others according to my ability and judgement; I will keep them free from distress and respect their human rights.

I will never offer treatment or advice which might needlessly harm a client.

I will only offer treatment or advice within my sphere of professional competence, and will respect the judgement and actions of other professionals within their own.

I will act with honesty and integrity, and in particular I will avoid any potential exploitation of clients.

What I see or hear in the course of the treatment or even outside of the treatment, in regard to the life of my clients, which falls within the bounds of professional confidentiality, I will keep private, as far as it is legal, reasonable and practicable to do so.

I will fulfil this pledge and refrain from violating it; If I break it and swear falsely, may my colleagues hold me to account for doing so.

Although its wording clearly needs to be modernised, the basic principles of the Hippocratic Oath have stood the test of time, and it seems to me to apply as well, if not better, to the psychological therapies as to traditional medicine.  I therefore hope that my adapted version, or some similar version, might be found useful by professional organisations, as a guide for modern therapists.

Excerpt from The Discovery of Hypnosis: The Complete Writings of James Braid

www.James-Braid.com

I shall now cite from a paper [the middle section of “Magic, Hypnotism, Mesmerism, etc., considered historically and physiologically”] actually published by me in The Medical Times for December 28^th 1844, a few of the wonders recorded in Ward’s “History of the Hindoos”, which they represent as facts and as special gifts imparted to them in token of the great superiority of their religious system, of inducing a state of self-hypnotism, or ecstatic trance.  They produce this condition by certain postures or modes of sitting – the minds of the devotees being engaged in acts of fixed attention, by looking at some parts of their own bodies, or at inanimate or ideal [i.e., imaginary] objects; at the same time holding their breath, i.e., suppressing their respiration.  My modes of explaining these alleged marvels are given within parentheses.  I may premise, however, that whatever idea occupies the mind of the subject before he passes into the condition, or whatever may have occurred to it accidentally or through the suggestion of others subsequently, will ever after be realised, under similar combination of circumstances, in consequence of the power of suggestion and double-conscious [dissociated] memory, as manifested in some patients even in the sub-hypnotic or waking condition, when what have been called the vigilant or waking phenomena are producible; and still more certainly during the full, active, double-conscious condition.  These principles alone, and the vivid state of the imagination, explain most of the marvels; but, with the parenthetic explanations, I trust to make them sufficiently obvious to any candid and intelligent person.

The Yogee [i.e., master of yogic meditation] who has perfected himself in the three parts of sungyamu [yogic “self-mastery”] obtains a knowledge of the past and of the future (quickened memory and excited imagination); if he apply sungyamu to sounds, to their meaning and to the consequent results, he will possess, from mere sound, universal knowledge (hypnotic patients imitate, with the utmost precision and with the greatest facility, the vocal enunciation of any language, but do not understand the meaning of the words which they utter).  He who applies sungyamu to discover the thoughts of others will know the thoughts of all.  (He will believe and talk as if he did so.)  He who does the same to his own form, and to the sight of those whose eyes are fixed upon him, will be able to render his body invisible, and to dim the sight of the observers. (Through the force of imagination, or fixed attention, or suggestion.)  He who, according to these rules, meditates on his own actions, in order that he may discover how he may most speedily reap the fruits of them, will become acquainted with the time, cause, and place of his own death.  He who, according to these rules, meditates on the strength of the powerful, so as to identify his strength with theirs, will acquire the same.  (Through concentrated attention and conviction of their physical energy, there is a most amazing manifestation of increased muscular power.)  He who meditates, in the same manner, on the sun as perfect light, will become acquainted with the state of things in every place.  (He will believe and speak as if he really did.)  By similar application of sungyamu to the cup at the bottom of the throat, he will overcome hunger and thirst; by meditation on the basilar suture, he will be capacitated to see and converse with deified persons, who range through the aerial regions; by meditation on extraordinary presence of mind, he will obtain a knowledge of all visible objects; by meditating on the seat of the mind, or on the faculty of reason, he will become acquainted with his own thoughts and those of others, past, present, and future; by meditation on the state of the Yogee who has nearly lost all consciousness of separate existence, he will recognise spirit as unassociated and perfect existence.  (Belief and vivid imagination.)  After this he will hear celestial sounds – the songs and conversations of the celestial choirs; he will have the perception of their touch in their passage through the air, his taste will become refined, and he will enjoy the constant fragrance of sweet scents.  (All this I can easily cause hypnotic patients to realise, through suggestion and their fervid imagination.)  When the Yogee, by the power of Samadhi [meditation], has destroyed the power of those works which retained the spirit in captivity, he becomes possessed of certain and unhesitating knowledge; he is enabled to trace the progress of intellect through the senses, and the path of the animal spirit through the nerves.  After this he is able to enter into any dead or living body, by the path of the senses – all the senses accompanying him, as the swarm of bees follows the queen bee; and, in this body, to act as though it were his own.  (Now, all this extravagance I can easily make hypnotic patients imagine themselves accomplishing – but, of course, it is only imaginary, just as such feats are accomplished in dreams.)

The collected power of all the senses is called the animal soul, which is distinguished by five operations connected with the vital air, or air collected in the body.  The body of the Yogee who, according to the rules of Dharanu, Dhyanu, and Sumadhee [concentration, meditation, and mystic union], meditates on the air proceeding from (…) to the head, will become light as wood, and will be able to walk on the fluid element.  He who, in the same manner, meditates on the ear and its vacuum, will hear the softest and most distant sounds, as well as those uttered in the celestial regions, etc.  (This accords with my proposition, that calling attention to any organ or function will exalt the activity of the function positively, as well as excite ideas con­nected with such organ or function.)  He who meditates on vacuum will be able to ascend in the air.  (Imaginary ascent.)  He who meditates, by the rules of sungyamu, and in a perfect manner, on the subtle elements, will overcome and be transformed into those elements; he will be capacitated to become as rarefied and atomic as he may wish, and proceed to the greatest distance; in short, he will be enabled to realise in himself the power of Deity, to subdue all his passions, to render his body invulnerable, to prevent the possibility of his abstraction being destroyed, so as to subject himself again to the effects of actions.

“By applying sungyamu to the division of the four last minutes of time, he who perfects himself in this will obtain complete knowledge of the separate elements, atoms, etc., which admit not of division of species, appearance, and place.  This knowledge brings before the Yogee all visible objects at once, so that he does not wait for the tedious process of the senses.  (Imagination, lively faith, and fixed attention, until ideas became too vivid to be corrected by an appeal to the senses and sober reason.)

The following paragraph is from the “Dabistan” [Dabistān-i Mazāhib, a 17^th century Persian religious text of a syncretistic nature]:–

The Sipasian [an ancient Zoroastrian sect] and the historians relate that, whoever carries this process to perfection rises above death; as long as he remains in the body, he can put it off and be again reunited to it; he never suffers from sickness, and is fit for all business.

So much for the lively fancy and fervid faith of these religious enthusiasts, during their dreams, in the state of self-induced hypnotism, through fixing their thoughts or sight upon some part of their own bodies, or on some ideal [i.e., imaginary] or inanimate objects, and holding their breath, or suppressing their respiration.  By an appeal, therefore, to the feats of the Hindoos, I might claim for hypnotism, or self-induced trance, quite as high pretensions for its capability of inducing clairvoyant marvels as anything adduced by the animal magnetists or Mesmerists, with all the exoteric or alleged aid which they profess to communicate or impart to their subjects, by whatever name they may call it – whether magnetic, Mesmeric, odylic, nervous, or vital force transferred from the operators into the bodies of their subjects.

Hypnotherapy and Rational Psychotherapy as Psychoprophylaxis

Copyright (c) Donald Robertson, 2010.  All rights reserved.

Following the large-scale use of Pavlovian hypnotherapy at the start of the 20th century, as a means of reducing pain and anxiety during childbirth and dealing with associated complications, Soviet clinicians began to employ rational psychotherapy in a group setting as a preventative (prophylactic) against pain during childbirth.  These techniques were generally influenced by Pavlovian conditioning theory.  Today we would probably refer to what the Soviet therapists called “psychoprophylaxis” as “psycho-education”.

In a collection of papers by experts in this field, Shugom provides a brief review of Soviet statistical data on the results of psychoprophylaxis of labour pain.  His first observation is that the duration of labour among women who have attended group rational psychotherapy seminars in preparation for childbirth is reduced by an average of two hours, compared to childbirth under anaesthetic, or 3-4 hours compared to labour without anaesthesia.  Shugom provides a table illustrating this conclusion by reference to data from fifteen studies by different authors.  Eight of these were studies specifically on psychoprophylaxis, which report average duration of labour to be between 5hrs 40 min. and 16hrs.  The seven other studies, on duration of labour without psychoprophylaxis, found labour duration to range from 11hrs to 24hrs.

Soviet Rational Psychotherapy for Prophylaxis of Pain during Childbirth

Shugom reports the following mean figures collated from many thousands of cases, measured on a standard five-point clinical scale,

Summing up the results of pain prevention by the psychoprophylactic method on the basis of the reports of 20 authors, including 9 foreign authors, using the materials of more than 15,000 childbirths, A. Nikolayev reported at the Tenth All-Union Congress of Obstetrics and Gynaecology the following data on the effectiveness of rendering childbirth painless by the psychoprophylactic method:

Complete effect of preparation (5): 45-50%
Considerable partial effect (4): 30%
Insignificant (3): 15%
No effect (2): 4-5%

In old studies of this kind, complete or significant partial improvement are often pooled to provide a success rate figure, which in this case would be 75-80%, based on Nikolayev’s data from 15,000 women undergoing childbirth following psychoprophylaxis by the Soviet method. 

Shugom also provides a table of data, summarised in the chart above, which (excluding one site where the number of participants was unknown) shows that among a total sample of 5,610 pregnant women at seven different sites in the Soviet Union, psychoprophylaxis resulted in complete or significant reduction of pain during 83% of childbirths, on average.  Comparison of the figures across sites shows that they are fairly consistent, lending some additional credibility to the finding.

In a direct comparison between the psychoprophylactic method and suggestion hypnotherapy for labour pain, another Soviet author, Velvovsky, reported data from exactly 1,000 childbirths.  In this study, 641 women had preventative rational psychotherapy (psychoprophylaxis) whose reported level of pain during labour was compared directly against a sample of 113 women who received hypnotherapy.  See my article on Velvovsky’s comparison between psychoprophylaxis and hypnotherapy for a more detailed discussion.  The graph below places the data on psychoprophylaxis from Nikolayev’s study alongside the figures from Velvovsky’s direct comparison,

Combined data from Velvovsky and Nikolayev's Studies

These figures need to be treated with caution because little information is provided on the studies and any comparison the two sets of data can only be very tentative indeed.  However, they may provide some inspiration for further research in this area using modern research design methods.  There certainly seems to be an indication, from large numbers of women treated with these methods in the Soviet Union, that psychological methods can reduce the pain of labour to varying degrees, and that the inclusion of Pavlovian-style relaxation hypnosis may substantially improve the effect of psycho-education and suggestion, although non-hypnotic relaxation techniques may be found to have similar properties.

References
Velvovsky, I.; Platonov, K.; Ploticher, V.; Shugom, E.   (1960).  Painless Childbirth through Psychoprophylaxis.
Zdravomyslov, V.I.   (1956).  ‘The Significance of Psychotherapy in Obstetrics and Gynecology’ in Psychotherapy in the Soviet Union, Ralph B. Winn (ed.).  Grove Press: New York.

Copyright (c) Donald Robertson, 2010.  All rights reserved.

These data were reported by I.A. Zhukov in a paper presented at, apparently, the last conference on psychotherapy in the Soviet Union, held in 1956.  Although this is an old study, and doesn’t provide enough information to meet modern research design criteria, it has the benefit of a control group and the figures come from a reasonably large sample of 580 patients.  Participants were treated for different skin conditions in spa resorts at Sochi, Matsesta and the Caucausus, where hypnotherapy was combined with recuperation, sulphur mineral baths and sunbathing.  The patients were mainly (about 92%) women, apparently aged between 20-60, their skin conditions were of one to twenty-five years in duration, and Zhukov says their case histories contained “in all instances some psychological traumata.”  He provides separate data on those patients presenting with eczema, neuro-dermatitis, and psoriasis, which he says in most cases “was quite extensive and affected the head, the trunk, and the legs and feet.”

Comparison of Hypnotherapy and Spa Treatment

Half of the patients constituted a control group who received spa treatment as usual, whereas the other half, the experimental treatment group, received the same spa treatment plus hypnotherapy.  Treatment consisted of seventeen sessions of direct suggestion hypnotherapy based on a Pavlovian conditioning model.  This approach usually involved prolonged periods of deep hypnotic relaxation combined with suggestions of symptom remission and general well-being.  Zheltakov, who presented to the same conference, observed that many of these dermatological patients also suffered from neurotic anxiety and problems sleeping, which might now be described as more “stress-related” or psychosomatic cases.  Zhukov describes his technique as a form of Braidism,

All our hypnotic treatments were conducted by means of the so-called fascination technique (involving staring at some bright object), the spoken word conveying the required suggestion.  Evening hours were chosen for the hypnotic sessions, insofar as this time was most compatible with the resort regimen and permitted us to extend the patients’ sleep to ten or twelve hours.  the sessions were conducted in the patients’ own words.

On average, the control group, who received spa treatment only, reported marked or complete improvement in 23% of cases.  By contrast, those who received hypnotherapy in addition to treatment as usual were marked or completely improved in 63% of cases.  These figures were broadly similar for different conditions, although neuro-dermatitis patients exhibited most improvement with 70% of the hypnotherapy group showing at least marked improvement, compared to 27% of the treatment as usual control group.

There was a follow-up of this study of eczema, neuro-dermatitis, and psoriasis.  Practically all the patients of the experimental group and many patients of the control group were contacted by means of a questionnaire, and 229 answers were received [i.e., a 39% response rate].  The answers overwhelmingly testified to the permanent nature of the improvements.

According to these data, the vast majority of patients, 85% in the treatment as usual group and 98% in the hypnotherapy group, reported at least slight improvement.  However, whereas only 10% of patients in the spa treatment control group were classed as “completely recovered”, three times as many, 31% of the hypnotherapy patients met criteria for full recovery. 

References
Zheltakov, M.M.  (1961).  ‘The use of hypnosis and conditioned-reflex therapy in dermatology’, in Winn, Ralph B. (ed.), Psychotherapy in the Soviet Union.
Zhukov, I.A.  (1961).  ‘Hypnotherapy of dermatoses in resort treatment’, in Winn, Ralph B. (ed.), Psychotherapy in the Soviet Union.

Excerpt from the NCH August Research Snippet by Donald Robertson

See the rest of this article online at the NCH website,

http://www.hypnotherapists.org.uk/1502/mindfulness-metacognition-and-hypnosis-august-research-snippet/

In 2006, Steven Jay Lynn collaborated with the Buddhist teacher Lama Surya Das, and two other researchers, in an attempt to explore the possibility of combining elements of Buddhist mindfulness meditation practice, cognitive therapy, and hypnosis, drawing on recent research in cognitive psychology.

Mindfulness versus Thought Suppression

Over the past couple of decades, enthusiasm for mindfulness meditation techniques derived from Buddhism has flourished among cognitive-behavioural therapists, inspired by the early success of Jon Kabat-Zinn’s meditation programme for stress management.  Meditation and acceptance strategies have been used to counteract the tendency of many clients to try to suppress, control, or “fight” distressing thoughts.  Lynn et al. refer to the recent study by Wegner and his colleagues, which found that when people tried to deliberately suppress a thought there was evidence of a “rebound effect” in which they subsequently experienced more intrusions of the thought than a control group who were simply asked to think freely about the same thing.  Other studies have found evidence that emotional suppression can inhibit memory and problem-solving and increase physiological signs of nervous arousal.  Lynn and his colleagues report that of nearly a hundred subjects who were asked to keep their minds blank while listening to hypnotic suggestions, only one reported any success. 

Where thought-control strategies backfire, mindfulness and acceptance have been seen as offering an alternative way of responding to distressing experiences.  Lynn et al. follow other contemporary cognitive-behavioural therapists in contrasting non-judgemental mindfulness and acceptance with the unhealthy suppression of thoughts and feelings.  (However, they fail to mention that experimental studies on this “rebound” effect in thought suppression have produced some mixed results – q.v. Clark & Beck, 2010, for a more detailed review.)  Lynn et al. also cite a 2003 meta-analysis of mindfulness-based cognitive therapy and stress reduction approaches by Baer, which found a mean effect size of 0.59 (a medium-sized treatment effect) for this approach across various emotional problems and medical conditions.  In other words, it probably works, but the effects are comparable to those of other therapies and not dramatically superior to them.

See the rest of this article online at the NCH website,

http://www.hypnotherapists.org.uk/1502/mindfulness-metacognition-and-hypnosis-august-research-snippet/

Copyright (c) Donald Robertson, 2009.  All rights reserved.

Relaxation techniques constitute some of the simplest, most versatile, and most effective interventions in the therapeutic armamentarium.  Relaxation is particularly central to traditional hypnotherapy which, as practised by James Braid, originally aimed to induce various degrees of “nervous sleep” for therapeutic recuperation in many clients.  Relaxation is equally central to traditional behaviour therapy techniques such as Wolpe’s systematic desensitisation and is frequently employed in modern CBT.

However, therapists often fail to make elementary distinctions between different forms of relaxation which could be of considerable importance to the outcome of treatment.  The word “relaxation” was not in common use in its modern sense prior to the 20th century and it is used today to describe a multitude of different techniques, often on the assumption that they are somehow equivalent in their results.

Research on behaviour therapy led to the observation that anxiety and tension do not manifest in all aspects of psychological and physiological functioning equally.  Someone can have tense shoulders but very relaxed facial muscles, for example.  However, more significant differences can exist between different neurological response systems, e.g., cognition, behaviour, and physiology.  In our approach, we might a distinction, like the folk-psychology one between thoughts, actions, and feelings.  However, we use the terms cognition, behaviour and affect (including “feelings” in the sense both of emotions and autonomic sensations).

A. Affect and autonomic sensations including the feelings of anxiety and physiological responses such as heart rate, blood pressure, etc.

B. Behaviour including all tension in the musculature of the body and even slight movements, etc.

C. Cognitive arousal including racing thoughts, narrowing of attention, and fearful appraisals, etc.

To some extent, relaxation in one of these response systems may, sometimes after a delay, produce relaxation in the other systems, but this is not always the case.  The lack of correlation between them has been referred to as “desynchrony”.  Indeed, it’s very common to observe groups of people doing meditation or relaxation techniques who are clearly frowning, fidgeting, clenching their jaws, hunching their shoulders, or tensing other parts of the body while apparently feeling extremely mentally calm and serene.  Likewise, people who learn to relax their body, even if they succeed in reducing muscle tension and even lowering heart rate, will often report that their mind begins racing, especially in the early periods of practice.

As it happens, different relaxation techniques can be seen to focus differentially upon these response systems.  For example,

A. Breathing techniques arguably come closest to directly influencing heart rate and other physiological responses.

B. Tension-release techniques such as Jacobson’s influential progressive muscle relaxation (PMR) approach directly influence the level of muscular tension in the body.

C. Meditation techniques such as Herbert Benson’s “relaxation response” method, or other concentrative approaches, and mindfulness meditation techniques of a more contemplative nature, may be the most direct way of reducing cognitive arousal and slowing down thinking.

Understanding this simple distinction can help to better match the intervention to the needs of the individual client and the nature of their presenting problem.

Copyright (c) Donald Robertson, 2010.  All rights reserved.

In one of the earliest books on assertiveness training, Cotler and Guerra (1976) describe four common “myths”, which underly recurring themes in the belief systems of non-assertive individuals. These can be viewed as myths, misconceptions, irrational beliefs, assumptions or demands, etc., which determine feelings and behaviour in anticipation of, or in response to, challenging interpersonal situations. Assertiveness training may involve developing an awareness of such myths, watching out for signs of them in yourself or even others, challenging them directly, and replacing them with more flexible, adaptive, rational, balanced, and constructive, alternative beliefs.

1. The Myth of Anxiety

The myth of anxiety is incredibly common, almost universal. It is essentially the belief that one must not become anxious, the fear of anxiety itself. However, it can take several forms. One may fear becoming anxious because the very sensations that accompany it are perceived as dangerous, horrible, or overwhelming. In addition to this, one may fear that anxiety should come through in one’s body language or behaviour and be witnessed by others. This fear of being seen to be anxious is often experienced as shame or embarrassment. The fear may be that physiological symptoms of anxiety, such as blushing, sweating, or trembling, may be observed by other people. Moreover, it may also be feared that anxiety will lead to mistakes in speech or behaviour, e.g., stammering, losing concentration, forgetting what you want to say, stumbling over words, etc. There are really a cluster of myths here that assume anxiety is somehow dangerous or shameful, and that it is therefore abnormal to be anxious. People generally keep their anxieties a secret, of course, which means that we all tend to greatly underestimate how common such fears actually are. In fact, some degree of anxiety in social situations is so common as to be the norm, especially when the situation is perceived as unfamiliar, demanding, problematic, etc. Anxiety is the body’s way of protecting against perceived threats but it can, unfortunately, create more problems in social settings, so that fear of embarrassment becomes a self-fulfilling prophecy because it causes avoidance or mistakes. Learning to accept sensations of anxiety as normal, harmless, and nothing to be ashamed of, will gradually reduce their impact on your behaviour, and ultimately leads to a reduction in anxiety itself in most situations. By contrast, trying to “fight” anxiety tends to make it worse. Accept your anxiety as normal, forgive yourself for making mistakes, and you will allow yourself the freedom to learn and develop more confidence.

2. The Myth of Modesty

This myth holds that it’s wrong to give or receive praise, or to praise oneself. People often assume it’s crass, arrogant or unseemly, to “blow your own trumpet.” Sometimes that’s true. However, praise and compliments function as what psychologists call social “reinforcement”, and they’re quite important to the modification and management of our thoughts, feelings, and actions. The person who refuses to say anything remotely positive about themselves, or to take justifiable pride in their achievements, is like a company that refuses to pay its employees. Most people need these small symbolic rewards more than they realise and the absence of praise or reinforcement can lead to dwindling motivation. Moreover, discounting or overlooking one’s positive qualities often leads to a distorted self-concept, where weaknesses are recognised but not strengths. Having such an unbalanced view of oneself is a recipe for future problems. Learning to accept reasonable praise and to speak positively of oneself is central to healthy, assertive behaviour. Likewise, learning to praise other people, where appropriate, will obviously tend to improve relationships.

3. The Myth of the Good Friend

This myth assumes that a good friend would be able to read your mind and instinctively know what you want, without any effort to communicate on your part. “I shouldn’t have to tell you that something’s wrong!” “If you were a good friend, you would know what’s bothering me.” However, people are not telepathic and no matter how well they know you, it’s unreasonable to expect them to read your mind. On the contrary, you should assume that assertive communication will probably (with some exceptions) require some degree of courage and effort on your own part. You don’t have a right to expect people to intuitively know what’s wrong. However, they do have a right to expect you to tell them if you want them to know something. Hence, there’s no point becoming angry, frustrated, or blaming others if they don’t live up to such impossibly high standards. In a way, the “good friend” myth is simply an excuse for avoiding being assertive. It would be better to accept that some work is involved in making others, even your best friends, understand what you want to communicate to them.

4. The Myth of Obligation

This myth assumes that it’s wrong to say “no” to requests because you have a duty, an obligation, to do certain things. You undoubtedly have some obligations in life, but perhaps not as many as you may think. Are these real obligations or just imaginary ones? Are you imposing unreasonable or rigid demands on yourself or others? You have a right to refuse inappropriate or unreasonable requests. Likewise, other people have an equal right to refuse your own requests sometimes. You’re not in this world to live up to their expectations and they’re not in this world to live up to yours. People are often tortured by the fact that they assume they “must” or “should” do certain things, which are, in fact, not commandments written in stone. This is especially true when obligations turn into absolute or rigid demands. For example, you might have a duty to your boss to do your job properly, but you’re not absolutely obliged to do so if you think the workload is unreasonable or excessive. There may be consequences to refusing other people’s demands but the decision is yours to make. It’s your choice and not something that can be dismissed as just something you “have to” do, whether you like it or not. There’s always an alternative, even if it’s not a very comfortable one. A strong sense of “obligation” tends to be a theme with non-assertive individuals, who often place unrealistic demands on themselves and others. It’s usually helpful to replace this “duty” orientated mind-set with one that’s more based upon the notion of “rights”, an extension of your basic human rights. You may have a duty to be polite to others, to some extent, but you may also have a right, a “perfect right”, to tell them when you strongly object to their behaviour. It’s often necessary in assertiveness training, to focus on rights and elaborate them, in order to counter-balance an overly-rigidified sense of duty, commonly expressed in such phrases as “I must…”, “have to…”, “should…”, “need to…”, etc. Of course, other people probably have the same basic rights that you do. The central principle of assertiveness training is your perfect right to communicate assertively in appropriate ways, and other people have a perfect right to be assertive in appropriate ways with you too.

Reference
Cotler, S.B. & Guerra, J.J. (1976). Assertion Training: A Humanistic -Behavioral Guide to Self-Dignity. Champaign: Research Press.

Cognitive-Behavioural Hypnotherapy

Copyright (c) Donald Robertson, 2010.  All rights reserved.

The process of formulating clients’ problems and goals is integral to different forms of cognitive-behavioural therapy (CBT) and also to our approach to cognitive-behavioural hypnotherapy (CBH).  Problem statements should express, in the client’s words, specifically what they want to change.  Essentially, this involves a description of the situation or event that triggers a problematic response, either the full range of relevant triggers or a specific example.  This definition can be made more complete by employing the basic folk psychology distinction between “thoughts”, “actions” and “feelings”, or cognition, behaviour, and affect. 

For example, a client with social anxiety may have the following affective-behavioural-cognitive (ABC) formulation,

This could be phrased in terms of the following problem definition,

In response to social situations, such as talking to strangers at parties, I feel anxious and shakey, I avoid making eye-contact and initiating conversations, and I think that people are bound to criticise me and I won’t know what to say.

The corresponding treatment goal might be phrased as follows,

In response to social situations, such as talking to strangers at parties, I want to feel calm and relaxed, make natural eye-contact and initiate conversations, and think that people are unlikely to be critical but even if they are I can cope with them.

Other considerations may be necessary depending upon the nature of the presenting problem and treatment being employed, etc.  For example, when using exposure therapy, it is important to identify specific anticipated trigger situations that a time and date can be attached to.  Likewise, SMART goals are often used in therapy, which are specific, measurable, achievable, relevant (or realistic), and time-limited. 

For assessment purposes, and sometimes to motivate the client, it may be helpful to incorporate some reference to the wider or longer-term impact of the problem.  For example, the socially-anxious client above might add “…and this prevents me from making friends or forming relationships” as a longer-term consequence of the problem.  It may also be helpful to specify the goal in terms that are more quantifiable and measurable, e.g., “I want to reduce my anxiety by 50%” or “I want to initiate at least three conversations a week with people I don’t know well”, etc.

Copyright (c) Donald Robertson, 2010.  All rights reserved.

(This is a brief excerpt from my forthcoming book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, published by Karnac and available for pre-order online now.)

Plato has a fine saying, that he who would discourse of man should survey, as from some high watchtower, the things of earth.  (Marcus Aurelius, The Meditations) 

Take a moment to settle into your posture and make yourself comfortable…  Close your eyes and relax… [Pause.]  Be aware of your breathing…  Notice the rhythm and pattern of the breath…  Do nothing for while, just be content to contemplate your breathing more deeply… [Pause.]  Now, begin by paying attention to the whole of your body as one…  From the top of your head, all the way down into your fingers and down into your toes…  Be aware of your body as one… every nerve, muscle and fibre… Don’t try to change anything.  Don’t try to stop anything from changing…  Some things can change just by being observed… 

Just be content to notice whatever you notice, and feel whatever you feel…  Be a passive, detached observer…  As you continue to relax, turn your attention deeper within, and become more aware of your body… until you can almost imagine how you look right now…  Begin to picture yourself as if seen from the outside… Now just imagine that you are taking a step back and looking at yourself.  It really doesn’t matter how vividly you can picture yourself, it’s just the intention, just idea that matters.  Imagine your body posture… your facial expression… the colour and style of your clothing…

Now keep looking at the image of yourself resting there, and imagine your own feet are gently leaving the ground.  You begin floating serenely upwards, slowly and continuously, rising upwards.  All the while your gaze keeps returning to your own body, now seated there below you as you rise above it.  Keep looking down toward your body as you float higher and higher….  The roof and ceiling disappear, allowing you to float freely upward.  Gazing down you see yourself seated comfortably below in the building, looking contented and contemplative.  You see all the rooms, and any other people around.

As you continue to float gently higher and higher, your perspective widens more and more until you see the whole surrounding area.  You see all the buildings nearby from above.  You see the people in buildings and in the streets and roads.  You observe people far below working, or walking along the pavement, people cycling or driving their cars, and those travelling on buses and trains.  You begin to contemplate the whole network of human lives and how people everywhere are interacting with each other, influencing each other, encountering each other in different ways…

Floating higher, people become as small as ants below.  Rising up into the clouds, you see the whole of the surrounding region beneath you.  You see both towns and countryside, and gradually the coastline comes into view as your perspective becomes more and more expansive…  You float gently up above the clouds, above the weather, and through the upper atmosphere of the planet Earth…  So high that you eventually rise beyond the sphere of the planet itself, and into outer space…  You look toward planet Earth and see it suspended in space before you, silently turning… resplendent in all its majesty and beauty…

You see the whole of your home planet… the blue of the great oceans… and the brown and green of the continental land masses…  You see the white of the polar ice caps, north and south…  You see the grey wisps of cloud that pass silently across the surface of the Earth…  Though you can no longer see yourself from so far above, you know and feel that you are down there on Earth below, and that your life is important, and what you make of your life is important.  Your change in perspective changes your view of things, your values and priorities…

You contemplate all the countless living beings upon the Earth.  The population of the planet is over six billion people…  You realise that your life is one among many, one person among the total population of the Earth…  You think of the rich diversity of human life on Earth.  The many languages spoken by people of different races, in different countries… people of all different ages… newborn infants, elderly people, people in the prime of life…  You think of the enormous variety of human experiences… some people right now are unhappy, some people are happy… and you realise how richly varied the tapestry of human life before you seems.

And yet as you gaze upon the planet Earth you are also aware of its position within the rest of the universe… a tiny speck of stardust, adrift in the immeasurable vastness of cosmic space…  This world of ours is merely a single planet, a tiny grain of sand by comparison with the endless tracts of cosmic space…    a tiny rock in space, revolving around our Sun… the Sun itself just one of countless billions of stars which punctuate the velvet blackness of our galaxy…

You think about the present moment on Earth and see it within the broader context of your life as a whole.  You think of your lifespan as a whole, in its totality…  You think of your own life as one moment in the enormous lifespan of mankind…  Hundreds of generations have lived and died before you… many more will live and die in the future, long after you yourself are gone…  Civilisations too have a lifespan; you think of the many great cities which have arisen and been destroyed throughout the ages… and your own civilisation as one in a series… perhaps in the future to be followed by new cities, peoples, languages, cultures, and ways of life…

You think of the lifespan of humanity itself…  Just one of countless billions of species living upon the planet…  Mankind arose as a race roughly two hundred thousand years ago… animal life itself first appeared on Earth over four billion years ago…  Contemplate time as follows…  Realise that if the history of life on Earth filled an encyclopaedia a thousand pages long… the life of the entire human race could be represented by a single sentence somewhere in that book… just one sentence…

And yet you think of the lifespan of the planet itself…  Countless billions of years old… the life of the planet Earth too has a beginning, middle, and end…  Formed from the debris of an exploding star, unimaginably long ago… one day in the distant future its destiny is to be swallowed up and consumed by the fires of our own Sun…  You think of the great lifespan of the universe itself… the almost incomprehensible vastness of universal time… starting with a cosmic explosion, a big bang they say, immeasurable ages ago in the past…  Perhaps one day, at the end of time, this whole universe will implode upon itself and disappear once again…  Who can imagine what, if anything, might follow, at the end of time, in the wake of our own universe’s demise…

Contemplating the vast lifespan of the universe, remember that the present moment is but the briefest of instants… the mere blink of an eye… the turn of a screw… a fleeting second in the mighty river of cosmic time…  Yet the “here and now” is important… standing as the centre point of all human experience…  Here and now you find yourself at the centre of living time…  Though your body may be small in the grand scheme of things, your imagination, the human imagination, is as big as the universe… bigger than the universe… enveloping everything that can be conceived…  From the cosmic point of view, your body seems small, but your imagination seems utterly vast… 

You contemplate all things, past, present and future…  You see your life within the bigger picture… the total context of cosmic time and space…  The totality is absolute reality…  You see yourself as an integral part of something much bigger, something truly vast, the “All” itself…  Just as the cells of your own body work together to form a greater unity, a living being, so your body as a whole is like a single cell in the organism of the universe…  Along with every atom in the universe you necessarily contribute your role to the unfolding of its grand design…

As your consciousness expands, and your mind stretches out to reach and touch the vastness of eternity…  Things change greatly in perspective… and shifts occur in their relative importance… Trivial things seem trivial to you…  Indifferent things seem indifferent…  The significance of your own attitude toward life becomes more apparent… you realise that life is what you make of it…   You learn to put things in perspective, and focus on your true values and priorities in life…  One stage at a time, you develop the serenity to accept the things you cannot change, the courage to change the things you can, and the wisdom to know the difference…  You follow nature… your own true nature as a rational, truth-seeking human being… and the one great nature of the universe as a whole…

Now in a moment you are beginning to sink back down to Earth, toward your place in the here and now…  Part of you can remain aware of the view from above, and always return to and remember that sense of serenity and perspective. 

Now you begin your descent back down to Earth, to face the future with renewed strength and serenity…  You sink back down through the sky… down… down… down… toward the local area… down… down… down… into this building…  down… down… down… You sink back gently into your body… all the way now… as your feet slowly come to rest upon the floor once again…

Now think about the room around you… Think about action… movement… think about looking around and getting your orientation…  raising your head a little…  Begin to breathe a little bit more deeply… a little bit more energetically… let your body feel more alive and ready for action… breathe energy and vitality into your body… breathe a little deeper and deeper again… until you’re ready to take a deep breath, open your eyes, and emerge from meditation… taking your mindfulness and self-awareness forward into life… beginning now… take a deep breath… and open your eyes now… when you’re ready… entering the here and now with deep calm and serenity…