1 Introduction

The contemporary definition of “stoic” is often used as an adjective to describe someone “not affected by or showing passion or feeling” [1], or as a noun, “one apparently or professedly indifferent to pleasure or pain” [1]. However, these definitions describe what is actually known as “lower-case stoicism”—a personality construction and coping adaptation often associated with individuals who have high thresholds for pain [2], ignore emotional cues, and view help-seeking behavior as a sign of deficiency [3]. What the present article will be discussing is “upper-case Stoicism”, which is meaningfully distinct from the narrow definition of its lower-case counterpart, as it describes an ancient school of Greek philosophy that has had tremendous influence on modern conceptions of mental health, how to live a flourishing and meaningful life, and on psychotherapeutic engagement. The contrast between these upper and lower case distinctions and the ethos of Stoicism is perhaps best described by Donald J. Robertson in his book, Stoicism and the Art of Happiness:

“The [Stoic] Sage conquers his passions by becoming stronger than them, not by eliminating all traces of emotion from his life. The Stoic ideal is therefore not to be passionless in the sense of being apathetic, hard-hearted, insensitive, or like a statue of stone or iron. Rather, it is to experience natural affection for ourselves, our loved ones, and other human beings, and to value our lives in accord with nature… to care sufficiently about ourselves and others but not enough to anxiously worry.” ([4], p. 55).

Unsurprisingly, lower-case stoic attitudes are associated with a high prevalence of mental health problems (often untreated due to toxic, unsophisticated notions of strength), whereas ways of living that subscribe to the tenets of upper-case Stoicism allow for greater self-awareness and emotional intelligence [3]. To understand Stoicism’s influence on modern mental health treatment and how it allows us to master our passions (rather than deny them, or conversely, be a slave to them), it is prudent to first examine the school’s impact on the most widely-used therapeutic modality in psychotherapy: Cognitive Behavioral Therapy (CBT).

Being trained in CBT is a virtual necessity for modern psychotherapists, as the modality is regarded as one of the most effective therapies in clinical circulation [5], with over 269 meta-analytic studies affirming its efficacy across a variety of patient populations [6], making it the most researched therapeutic modality in modern psychotherapeutic practice [7, 8]. The modality is dexterous enough to be clinically potent in the treatment of a wide range of psychological ailments, including anxiety [9, 10], depression [11, 12], insomnia [13], anger management [14, 15], Post-Traumatic Stress Disorder (PTSD) [16], Hoarding Disorder [17], suicidal ideation [18, 19], Substance Use Disorders [20], and others. CBT is a core component in the education of our future Psychologists and Social Workers [21], and many training institutes such as the Beck Institute for Cognitive Behavior Therapy and the Albert Ellis Institute provide continuing education on best practices for practitioners already in the field.

However, what is less acknowledged is how modern CBT arrived at its current station of excellence. Aaron Beck and Albert Ellis are the originators of cognitive therapy [22], but where did their ideas come from? The basic framework of cognitive restructuring and behavioral activation has remained present in the modality’s implementation since Ellis & Beck began their research in the 1960s, but current so-called “Third Wave” CBT variants such as Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and mindfulness-based therapies have expanded upon their framework throughout the twenty-first century [23, 121], developing more process-based variations. The present article demonstrates how the philosophical school of Stoicism was foundational to the inception of CBT [4, 24, 33, 120] as a major source of inspiration to Ellis & Beck [24,25,26,27], and has continued to inspire contemporary studies of human excellence in the field of Positive Psychology.

For the modern CBT practitioner, understanding the roots of the CBT framework is essential to efficacious practice. CBT textbooks and instruction manuals are littered with references to the works of Ellis & Beck, describing their shared assertion that our emotions are not simply responses to the events, situations, and the people in our lives, but are rather responses to our thoughts and beliefs about those events, situations, and people. This perspective can be seen in the conventional wisdom that “perception is reality”; or subjective reality, to be sure. Ellis & Beck arrived at this conclusion within the same 10-year span over the 1950s & 1960s [28], as they became dissatisfied with the prevailing therapeutic modality of the day, Psychoanalysis. Independently of one another, they began to question the efficacy of Psychoanalysis [29, 30] and explored alternative methods of alleviating their clients’ suffering.

2 Stoicism & CBT

Albert Ellis, a self-proclaimed student of Stoicism [25, 31, 32], sought inspiration from the Greek Stoic philosopher (and former slave) Epictetus as he created the modality of Rational Therapy, which eventually evolved into Rational Emotive Behavior Therapy (REBT) [29, 33]. Ellis specifically mentioned Epictetus in his landmark book on REBT, Reason and emotion in psychotherapy [34], and acknowledged that the logic of his new modality was not entirely original, stating that “many of the principles incorporated in the therapy of rational emotive psychotherapy are not new; some of them, in fact, were originally stated several 1000 years ago, especially by the Greek and Roman Stoic philosophers” ([35], p. 35). He later explicitly wrote that the central premise of REBT “was originally discovered and stated by the ancient stoic philosophers” ([35], p. 54). In particular, he gives credit to Epictetus’ assertion that “Men are disturbed not by things, but by the views which they take of them” [33, 35].

Ellis acknowledged other Stoic philosophers as well, such as Marcus Aurelius and Seneca, and Beck similarly reported that he was inspired by all three of these Stoics in his early writings on CBT [11, 24, 34, 36], and has stated generally that “the philosophical underpinnings [of CBT] go back thousands of years, certainly to the time of the Stoics, who considered man’s conceptions (or misconceptions) of events rather than the events themselves as the key to his emotional upsets” ([37], p. 3).

What is this philosophical school that was so inspiring to Ellis & Beck? Stoicism was founded by Zeno of Citium in Athens, Greece, in 300 B.C.E (38), who one day in late 4th Century B.C.E was transporting exotic treasures across the Mediterranean Sea as a Phoenician merchant. Tragically, the hull of his ship was torn apart by unseen rock formations beneath the water’s surface, and the entirety of his precious cargo was lost with his ship [38, 39]. With such bad lack and catastrophic loss, it would have been understandable for Zeno to have been thrown into a state of depression and disempowerment.

However, with a robust sense of resiliency that has been emulated for generations of Stoics in the millennia that followed, Zeno found solace and inspiration in the teachings of Xenophon, a student of Socrates who believed that we place far too much value and importance on the possession of material wealth and riches (such as those lost in Zeno’s shipwreck), and on our status in the social hierarchy and what others think of us [40]. For Socrates, one’s sense of wisdom (“Sophia” in Greek) and excellence of character (“arete” in Greek) was of the highest value [40]. The Greek “Sophia” also carries meanings of intelligence, rationality, and the ability to discern the best course of action in difficult situations [41].

Zeno took these values to heart, and made the mission of Stoicism “to help those who study it see the truth more accurately and engage in wiser thinking and living” ([43], p. 255). Similarly, a primary goal of CBT is to help people identify maladaptive ways of thinking, restructure them to be more adaptive and accurate, and practice behaviors and thought patterns that more closely align with their preferred ways of living [43,44,45]. Zeno’s emphasis on “wiser thinking” and rationality is literally built into the title of Ellis’ Rational Emotive Behavior Therapy. As described, the Socratic tenets of wisdom, rationality, and staying true to one’s character and sense of self during trying times are foundational to both Stoicism and cognitive therapeutic modalities.

While Beck referenced the Stoic inspirations for CBT in his early work [34, 36], teaching manuals both he and his daughter Judith Beck have written since 1980 [10, 45] contain no mention of Stoicism. However, psychologists have continued to draw therapeutic inspiration from Stoicism over the last 40 years [121,122,123,124,125], with the most prolific author of such efforts being Donald J. Robertson [2,3,4, 24, 33, 39]. Robertson has explained that when both Stoicism and CBT/REBT are boiled down to their most basic components, the foundational framework is the same—this being that both methodologies are based on common assumptions that our cognitive activity influences our mood and behavior, and that we have the ability examine and change our cognitive activity in ways that are advantageous to us [24, 33]. Further, if we recognize that an emotional state or particular behavior results in personal anguish, it is our responsibility as sentient beings to identify the cognitive activity that informs the anguish, and work to restructure it.

Ellis describes this process of identification and recalibration in REBT’s “ABCDE” model, in which individuals identify an Activating Event (A) that they responded to with a particular thought or Belief (B), the Consequence (C) of which was a self-identified undesirable emotion or behavior [29, 46]. Once these identifications have been made, we can then question and Dispute (D) the Belief (B) that led to the maladaptive Consequence (C), thus changing the Belief to be more adaptive – potentially resulting in an Effective new belief (E), that can be adopted moving forward [46, 47].

Beck utilized a nearly identical method in his 5-column Dysfunctional Thought Record for clients, which employs the same principles of identifying unhelpful automatic thoughts and Core Beliefs (Ellis’ “B” stage), and then challenging / restructuring them to form a more adaptive response [43, 45, 48] (Ellis’ “D” stage). Beck further specified different classic human errors that influence our ability to accurately assess the events and interactions in our lives (B), which he called “Cognitive Distortions” [11]. Among the most common are Catastrophizing (seeing only the worst possible outcome of a situation), Fortune Telling (expecting that a situation will turn out badly without adequate evidence), Magnification (exaggerating the importance or frequency of events), and All-or-Nothing Thinking (thinking in absolutes, such as “always” or “never”) [44, 45].

Both Ellis and Beck utilized Socratic methods of disputation to challenge and reframe (D) distorted beliefs (B) that informed negative emotions (C) [49]. These Socratic methods were of course developed by Socrates, who, as stated, had an influential role on Zeno and Stoicism. The type of self-analysis that Socratic Questioning in CBT inspires is eminently comparable to the foundational urgings of the Stoics [33].

If one were to code different notable quotations from the works of Seneca, Epictetus, and Marcus Aurelius using ABCDE ascriptions to identify commonalities between their philosophy and Ellis & Beck’s cognitive conceptualizations, the influence becomes clear. The following quotations have been coded in this way to break down just how influential Stoicism is on modern cognitive modalities, as Robertson has observed [24, 33]. Remember that A = Activating Event, B = Belief, C = Consequence, D = Disputation, and E = Effective new belief.

Seneca

“There are more things (A) likely to frighten us (C) than there are to crush us; we suffer more often in imagination (B) than in reality.”

-Epistles, 13.4

“One is only unfortunate (C) in proportion as one believes (B) oneself so.”

-Epistles, 78.13

Epictetus

“Men are disturbed (C) not by things (A), but by the view (B) which they take of them.”

-Enchiridion, 5

“It isn’t the one who has it in for you and takes a swipe at you (A) that harms you (C), but rather the harm (C) comes from your own belief about the abuse (B). So when someone (A) arouses your anger (C), know that it’s really your own opinion (B) fueling it.”

-Enchiridion, 20

“Any person (A) capable of angering you (C) becomes your master; he (A) can anger you (C) only when you permit yourself (B) to be disturbed by him.”

-Enchiridion, 28.

Marcus Aurelius

“If you are distressed (C) by anything external (A), the pain (C) is not due to the thing itself (A), but to your estimate of it (B); and this (B) you have the power to revoke (D) at any moment.”

-Meditations, 8.47

“You have power (D) over your mind (B), not outside events (A). Realize this (E), and you will find strength (C).”

-Meditations, 4.3

“It is not what men do (A) that disturbs us (C), but our opinions (B) of what they do. Take away those opinions (D) – dismiss your judgement that this is something terrible (D) – and your anger (C) goes away as well.”

Meditations, 11.18

When dissected in this way, one can plainly see how Ellis & Beck adapted the ethos of these poetic epigrams into their structured, prescriptive cognitive modalities. To this writer’s knowledge, a dissection of Stoic quotations through the ABCDE framework such as the one above has never been published before—though the relationship between Stoic wisdom and cognitive conceptualizations in REBT & CBT is often referenced in applicable literature [such as in [24, 34, 51].

3 Stoicism’s underacknowledged presence in modern culture

As the generators of such powerfully resonant wisdom, the Stoics have inspired many great minds that have impacted our modern culture—though, to be sure, this influence is underreported and thus not commonly known. Stoicism influenced the perspectives and intellectual development of both Benjamin Franklin [50, 51] and Ralph Waldo Emerson [50, 52], and was also a moral precursor to Christianity [50, 53]. In William Shakespeare’s tragedy Hamlet, the play’s namesake has a line in Act II, Scene 2 that is often compared to the wisdom of Epictetus and Marcus Aurelius—“There is nothing either good or bad, but thinking makes it so” [54]. The thinking (B stage of Ellis’ ABCDE, Belief) determining the quality (C) of the [no]thing (A), draws intuitive connection to the aforementioned 8.47 & 11.8 excerpts from Marcus Aurelius’ personal journal (later published as his Meditations, though he never intended its contents to be publicly consumed) [55].

In addition, the iconic Serenity Prayer written by Reinhold Niebuhr in the 1940s that begins every Alcoholics Anonymous meeting—“God, grant me serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference”—overtly emphasizes the dichotomy of control frequently referred to in Stoicism [56]. For example, Epictetus begins his handbook for Stoicism (The Enchiridion) by acknowledging this dichotomy, saying “Some things are up to us, and others are not… if you think that only what is yours is yours, and that what is not your own is not yours… then… you will not do a single thing unwillingly, you will have no enemies, and no one will harm you” ([57], p. 11).

Epictetus’ above assertion that energy is best directed towards what is within our control, which includes our judgements and perspectives [24], helped Naval Aviator James Stockdale survive seven and a half years in the infamous Hanoi Hilton prison camp during the Vietnam War [58]. A self-proclaimed student of Stoicism [58], Stockdale recalled in one of his memoirs that as he ejected from the cockpit of his plane that was shot down in enemy territory, and saw the North Vietnamese soldiers that were soon to be his tormentors waiting for him on the ground, he whispered to himself, “I’m leaving the world of technology, and entering the world of Epictetus” ([59], p. 189). He found the Stoic wisdom of Epictetus to be so crucial in surviving his captivity that he later wrote a book detailing how Stoicism gave him the strength to outlast his tormentors – Courage Under Fire: Testing Epictetus’s Doctrines in a Laboratory of Human Behavior [59].

Roberston [24] has drawn comparison between Stockdale’s internalization of Stoicism and the mindset of Psychiatrist Viktor Frankl, another prison camp survivor who was incarcerated 20 years before Stockdale’s fateful flight, and spent time in both Auschwitz and Dachau over a 3 year period during World War II [60]. Over the course of his internment, Frankl had a revelation that “everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances” ([61], p. 66). Frankl went on to write about his experiences in Man’s Search for Meaning [60], which today has sold over 16 million copies [61, 62]. His Stoic revelations became a core component of his own meaning-centered therapeutic modality, Logotherapy, and have substantially influenced techniques and practices in modern psychotherapy [63, 64].

4 Modern conceptualizations of mental health treatment

The previous examples of Stoicism in modern culture have common themes of personal empowerment and self-efficacy, which can also be found in Stoicism’s appeal for individuals to strive to become the “best version” of themselves ([42], p. 248); an assertion that has informed modern humanistic emphasis on self-actualization ([65], p. 116). However, Ellis and Beck developed their cognitive modalities in accordance with the twentieth century medical model of psychopathology, in which mental health treatment is conceptualized through the perspective that different areas of deficit (such as cognitive distortions and maladaptive coping mechanisms) need to be targeted and absolved in order for optimal health outcomes to be achieved [66]. Some have called this “business-as-usual psychology” ([68], p. 5), which endorses a disease model of human nature and does not make any appeal to personal development [67]. There is unquestionable utility to this approach, as REBT & CBT have alleviated a great deal of human suffering.

However, Dr. Martin Seligman—former President of the American Psychological Association (APA) and the founder of Positive Psychology—asserts that:

“If we want to flourish and if we want to have well-being, we must indeed minimize our misery; but in addition, we must have positive emotion, meaning, accomplishment, and positive relationships. The skills and exercises that build these are entirely different from the skills that minimize our suffering” ([69], p. 53).

Indeed, the lack of strength-oriented empowerment in traditional cognitive modalities leaves something to be desired in the way of maximal clinical efficacy. The disease model of psychopathology also does little to prevent mental health difficulties from occurring, as “the major strides in prevention have resulted from a perspective focused on systematically building competency, not on correcting weakness” ([70], p. xv—emphasis my own).

In addition, the complex and nuanced origins of mental health conditions often do not neatly fit into the problem/solution disease model format [70,71,72,73], as distilling the constellation of bio/psycho/social/spiritual stressors that inform a mental health condition to a single, targetable cause can be a Sisyphean endeavor. This has been acknowledged by the National Alliance on Mental Illness (NAMI), who state that “A mental health condition isn’t the result of one event” [74].

The disease model’s narrow focus encourages therapists to become preoccupied with the problems, limitations, and deficiencies of their clients [75], while important therapeutic outcomes such as increasing self-confidence and fostering optimistic attribution styles (allowing clients to recognize their own agency and ability to impact their environment) are deprioritized [75, 76]. When the first instinct of a therapist is to effectively ask, “What’s wrong with you?”, instead of “What’s right with you?”, our healers run the risk of becoming pathologizers and victimologists [71, 75].

Stoicism endorses the same reduction in maladaptive misappraisals as traditional REBT & CBT, but has additional direction to purposefully engage in empowering, uplifting practices that promote flourishing and thriving [41, 77,78,79]. In this way, Stoicism predicted the World Health Organization’s (WHO) definition of mental health roughly two millennia before it was written – “Mental health is a state of well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community… Mental health is more than the absence of mental disorders” [80]—emphasis my own. The National Institute of Mental Health (NIH) articulates the same message in their own definition, saying “Mental health is more than the absence of a mental illness” [81]. With such clear definitional language from WHO, NAMI, and NIH on what mental health is, it seems outdated to continue subscribing to the disease model as the most appropriate lens through which to conceptualize mental health treatment.

As the cognitive modalities that have helped so many enter the “4th Wave” of their evolution in the 21st Century [42, 82], they would be well served to incorporate the strength orientation utilized by another area of clinical practice that Stoicism has influenced: Positive Psychology.

5 Stoicism & positive psychology

“The modern Stoic sage is someone who transforms fear into prudence, pain into information, mistakes into initiation, and desire into undertaking.”

-Nassim Taleb, Antifragile: Things that gain from disorder ([83], p. 209)

The above quote from Nassim Taleb (a world-famous essayist, statistician, and economist – further demonstrating Stoicism’s reach into multiple disciplines beyond philosophy and psychology) personifies the Stoic ethos of transforming adversity into advantage. This same type of transformation is inherent in different constructs of Positive Psychology, which is “the scientific study of what goes right in life” ([68], p. 3), the goal of which “is to increase the amount of flourishing in your own life and on the planet” ([69], p. 36).

Indeed, there are Positive Psychology textbooks that specify flourishing as a common pillar of Stoicism and Positive Psychology [84], and acknowledge that “most contemporary views on how to achieve well-being and contentment were expressed by the ancient Greeks” ([85], p. 16), noting that the “long past of positive psychology stretches at least to the Athenian philosophers in the West” ([68], p. 5). Socrates was one such philosopher, whom we’ve noted is somewhat of an adopted great-grandfather to Stoicism as the intellectual patriarch of Xenophon and Zeno’s philosophical family tree.

Perhaps no one has written more about the shared commonalities between Stoicism and Positive Psychology than Tim LeBon – a self-identified “Stoic Life Coach” and Positive Psychologist who asserts that “Positive Psychology can become more complete and wiser if it incorporates ideas from Stoicism” [78], while also noting that Positive Psychology Interventions (PPIs) and Stoic exercises (such as mindfully orienting to what is within our control, pursuing wisdom, and being a virtuous, beneficent citizen) are strikingly similar to each other, with shared motivations and intentions [79, 85]. As a therapist with published works in both fields, few (if any) psychologists have articulated this connection as concretely as LeBon has.

For example, Positive Psychologist Carol Dweck has described Taleb’s definition of the modern Stoic without direct reference to the philosophical school or to Taleb, in what she calls a “Growth Mindset” – a cognitive stance that is grateful for setbacks and self-perceived failures in the striving towards one’s goals, reconceptualizing these shortcomings as meaningful data points to inform future growth and development [86]. Dweck argues that this reorientation crucially informs our ability to flourish, as it facilitates the understanding that “[our] basic qualities are things that [we] can cultivate through [our] efforts, [our] strategies, and help from others” ([87], p. 7). A Growth Mindset accepts failure as an unavoidable and necessary component of striving—a reality famously acknowledged by Teddy Roosevelt in his Man In The Arena speech, where he credits the individual:

“…who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming… who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat” [87].

Roosevelt has often been referenced as a paragon of Stoicism [88], and the above quotation is a clear indication of how his personal ethos embodies the Stoic spirit. Neither he nor Carol Dweck have a fear of failure. Rather, they welcome failure as a sign that they are effortfully striving towards an objective, and continue their pursuit with hard-won lessons learned.

It is a bittersweet human truth that our capabilities are often only realized when we are tested and challenged by significant adversity, tragedy, and defeat. Though painful, these valleys of languish set the table for an individual to identify internal qualities and resources that they may never have discovered otherwise. Realizing these strengths and putting them into practice is foundational to the phenomenon of “Post-Traumatic Growth” (PTG), or personal transformation and evolution that can occur in the aftermath of trauma [89]. Developed by psychologists Richard Tedeschi and Lawrence Calhoun, PTG is found in the experience of enhanced appreciation of life, increased sense of personal agency and strength, deeper connections with others, and recognition of new possibilities in life after persevering through extreme circumstances [90, 91].

Here we can see a corollary to Stoic thought, as demonstrated by Seneca’s assertion that no one is “more unhappy than someone to whom nothing adverse has ever happened—for such a man has never been allowed to test himself” (Seneca, On Providence, 3.3), and that “Destruction has often made room for greater prosperity. Many things have fallen in order that they might rise higher” (Seneca, Epistles 91.13). The Post-Traumatic Growth that Seneca speaks of is contingent on the strength-orientation of Dweck’s Growth Mindset, in which failure is not a finality, but rather fuel for development. Epictetus has recognized this as well, saying:

“Every difficulty in life presents us with an opportunity to turn inward and to invoke our own submerged inner resources. The trials we endure can and should introduce us to our strengths. Prudent people look beyond the incident itself and seek to form the habit of putting it to good use… Dig deeply, you possess strengths you might not realize you have.”

-Epictetus, The Art of Living, ([92], p. 17).

In the opinion of this writer, there is no better description of Post-Traumatic Growth than the above assertion from Epictetus. Tedeschi might agree, as he has made specific reference to Epictetus’ outlook on adversity in his Posttraumatic Growth Workbook ([93], p. 57), and he and Calhoun have acknowledged the Greek philosophic emphasis on how trauma can be “a catalyst for positive change” ([94], p. 31) in an updated version of their original Handbook of Posttraumatic Growth [95]. Despite the intuitive connection, acknowledgement of Stoicism and PTG’s common assertions is virtually absent in available research data bases such as APA Psych Info, APA Psych Net, PubMed, and others, as this author could only find two sources that passively allude to their kindred notions [96, 97] aside from Tedeschi & Calhoun’s aforementioned reference.

Indeed, the shared flavor of Stoicism and different constructs in Positive Psychology appears to be even less acknowledged than its imprint on modern cognitive modalities. Aside from the connections made by LeBon, the most common mention of similarity is the previously described mutual emphasis on flourishing and self-actualization, which as stated has been referenced in passing by different Positive Psychology textbooks. However, Seligman has identified the common emphasis on human Agency (capital “A” intended) in Stoicism and Positive Psychology in a recent publication [98]. He refers to Agency as “the theme of [his] life’s work” [98], and this is not surprising given his self-identified mission since 1997 as president of the American Psychological Association (APA) to promote human flourishing [68]; a pursuit which is aided by a strong sense of self-agency [67, 99,100,101].

In his book Flourish, Seligman describes Agency as “an individual’s assumption of responsibility for the continuous journey to develop one’s spirit” ([69], p. 150). Agency as a vehicle of spiritual self-development is a notion that Socrates strongly endorsed as well, as he believed that we are agents who are “responsible for our own character and for our own well-being” [98], and to not fully exercise our agency in the pursuit of a life worth living would be akin to letting “excellence perish” [98].

A primary assertion of the present article thus far has been that Socrates, Marcus Aurelius, Epictetus, Seneca, Albert Ellis, Aaron Beck, and Viktor Frankl are all in agreement that our well-being depends on our agentic responses to the events in the world around us, which can be seen in our purposeful selection of which beliefs, attitudes, thoughts, and actions to utilize in the face of adversity. We can confidently add Martin Seligman to this committee of agentic empowerment – both for his creation of the strength-oriented field of Positive Psychology, and more specifically, for his adaptation of Ellis’ ABCDE model to serve as a catalyst for growth and flourishing by changing the “E” from “Effective new belief” to “Energization” [102, 103].

This change is a meaningful reframe, as clients who engage in the cognitive restructuring techniques of REBT & CBT to dispute (D) the distorted thought processes (B) that informed their negative emotional states (C) can now harness the positive energy resulting from their successful disputation (“E—Energization” stage) to inspire future growth and flourishing. Such a change is enacted by promoting an energized optimistic attributional style, which conceptualizes the different sources of adversity (A) to be local (context specific), external (not involving one’s sense of worth or self-efficacy), and unstable (temporary) [102, 104].

The Stoics would undoubtedly argue that both the reduction of suffering (REBT & CBT) and promotion of flourishing (Positive Psychology) are necessary to facilitate a state of optimal well-being which they referred to as “Eudaimonia” (Eu = good, daemon = inner spirit) [105]. With its Greek philosophical origin, Eudaimonia unsurprisingly deemphasizes the importance of shallow, hedonic pleasure in favor of deeper, meaningful pursuits [105]. The Stoics believed that Eudaimonia could be achieved by “pursuing and developing the best in oneself” ([101], p. 202) (recall Socrates & Seligman’s emphasis on Agency) by living rationally and virtuously [106] (I.E., not succumbing to Cognitive Distortions or focusing on things outside of our control), and in a way that encourages personal growth, authenticity, meaning, fulfillment, and maximization of self-efficacy while sharing our lives with loved ones [25, 107]. Their descriptions of Eudaimonia bear striking resemblance to Seligman’s PERMA model of well-being ([69], p. 16).

6 Stoic eudaimonia = positive psychology’s PERMA

Over the past two decades, Seligman has distilled his theory of well-being and “authentic happiness” [108] to a construct composed of five elements, creating the acronym “PERMA” [68]. In harmonious concert, these elements create a roadmap for well-being which has been foundational to the principles and interventions in Positive Psychology. Each element is described below, accompanied by three quotations from the Stoics discussed thus far in order to demonstrate the shared outlook of Stoic Eudaimonia and Positive Psychology’s PERMA.

6.1 P—Positive emotion

“The pleasant life”, found in the present moment. Experiencing positive emotions such as gratitude, forgiveness, mindfulness, savoring, hope, optimism, and peace [68]. What we typically think of as a snapshot of happiness and life satisfaction.

“It is quite impossible to unite happiness with a yearning for what we don’t have. Happiness has all that it wants, and resembling the well-fed, there shouldn’t be hunger or thirst.”

-Epictetus, Discourses, 3.24.17

“In all things we should try to make ourselves be as grateful as possible.”

-Seneca, Moral Letters, 81.19

“The mind must be given relaxation – it will rise improved and sharper after a good break…it regains its powers if it is set free and relaxed for a while.”

-Seneca, On Tranquility of Mind, 17.5

6.2 E—Engagement

Intrinsically motivated participation in different activities that are subjectively rewarding as their own end, and whose level of difficulty aligns with the user’s skill. The achievement of “Flow” states – complete absorption and full-immersion in the task at hand, usually in a task that provides immediate feedback.

“When one is busy and absorbed in one’s work, the very absorption affords great delight.”

-Seneca, Epistles, 9.7

“At every moment keep a sturdy mind on the task at hand… doing it with strict and simple dignity… giving yourself a break from all other considerations.”

-Marcus Aurelius, Meditations, 2.5

“What man actually needs is not a tensionless state, but rather the striving and struggling for some goal worthy of him.”

-Viktor Frankl ([61], p. 105)

6.3 R—Relationships

Spending time with trusted others whom we love and choose to share our lives with, and to whom we are securely attached. Regularly enacting our social nature. As Seligman states, “other people are the best antidote to the downs of life, and the single most reliable up” ([69], p. 20).

“The men among whom your lot has fallen - love them, and truly”.

-Marcus Aurelius, Meditations, 6.39

“So long as we draw breath, so long as we live among humans, let us cherish humanity.”

-Seneca, On Anger, 3.43.5

“Nothing gives the mind so much pleasure as fond and faithful friendship.”

-Seneca, On Tranquility of Mind, 7.3

6.4 M—Meaning

The things in life that give you a subjective sense of direction, purpose, and fulfillment. Meaning comes from “belonging to and serving something that you believe is bigger than the self” ([69], p. 17). Working towards a selfless goal—not in a self-sacrificial way per se, but in a way that extends oneself beyond the self.

“Let all your efforts be directed to something, let it keep that end in view.”

-Seneca, On Tranquility of Mind, 12.5

“The light of a lamp shines on and does not lose its radiance until it is extinguished. Why shouldn’t your truth, justice, and self-control shine until you are extinguished?”

-Marcus Aurelius, Meditations, 12.15

“Be like a vine that produces grapes without looking for anything in return.”

-Marcus Aurelius, Meditations, 5.6

6.5 A—Accomplishment

Achievement for its own sake; a strong sense of Agency and self-efficacy as a result of one’s achievements [68, 109]. Conceptualizing self-improvement through a Growth Mindset.

“Man conquers the world by conquering himself.”

-Attributed to Zeno

“If a thing is humanly possible, consider it to be within your reach.”

-Marcus Aurelius, Meditations, 6.19

“How long are you going to wait before you demand the best for yourself?... Devote the rest of your life to making progress.”

-Epictetus, Enchiridion, 51

When clustered in this way, the complementary definitional components of well-being from disciplines of Positive Psychology and Stoicism becomes plain to see. Just as Seligman touts Agency as a primary ingredient of flourishing, Stoicism considers Eudaimonia to be “something noble souls can influence through their own efforts of philosophical reflection and virtuous activity” ([110], p. 248—emphasis my own). The aforementioned “philosophical reflection” was Stoicism’s version of psychotherapy [24], and the Stoics believed Eudaimonia to be the highest aim of this practice, asserting its embodiment to be “the secret of the flourishing life” ([111], p. 254). One can imagine Marcus Aurelius reading a copy of Seligman’s Flourish [68] two millennia before its publication, nodding in agreement.

As demonstrated, Stoicism has had a clear impression on both CBT/REBT and Positive Psychology. We are currently in the midst of a disciplinary pivot from treating pathology (with CBT/REBT) to emboldening strength-oriented empowerment (with PPIs), as the focus of “Fourth Wave” psychotherapies has been the promotion of human flourishing and how to construct a meaningful, fulfilling life [73]. This change is part of a 21st Century effort to align psychotherapeutic practice with the aforementioned definitions of mental health from NAMI, WHO, and NIH. To this end, CBT has begun incorporating a new future-oriented optimistic orientation that, while present in PPIs, has been absent in Third Wave CBT implementations. This evolution is being championed by Fredrike Bannink, a clinical psychologist who has taken the work of Ellis and Beck into the Fourth Wave of CBT with her creation of Positive Cognitive Behavioral Therapy (P-CBT).

7 Positive CBT

“To rid yourself of old patterns, focus all of your energy not on struggling with the old, but on building the new.”

-Dan Millman, Way of the Peaceful Warrior ([112], p. 105).

Bannink has stated that she formulated P-CBT in a purposeful effort to evolve from the medical model of psychopathology [71, 75, 82, 113], representing a conceptual shift “from problem analysis to outcome analysis or goal analysis” ([72], p. 9). The quote preceding this paragraph speaks to this shift in therapeutic focus—“not on struggling with the old” (problem analysis), “but on building the new” (outcome/goal analysis)—and Bannink refers to this specific quotation as representing the ethos of P-CBT (personal communication, March 26, 2023). Bannink’s P-CBT directs clients to focus on “desired behavior and better moments (exceptions to problems as opposed to undesired behavior and problem instances)” and to “identify their contribution to these better moments” [114]. Where traditional cognitive models (henceforth referred to as T-CBT) attempt to identify a problem and fix it, Bannink’s P-CBT seeks to identify examples of Agency and capability in a client’s life as evidence and inspiration for their ability to flourish in response to adversity.

As these examples are identified, the client’s perspective broadens beyond the narrow viewpoint of the acute situation centered in the crosshairs of T-CBT, and expands to encompass other experiences, memories, examples, and perspectives that can disconfirm the distorted belief informing the undesirable emotions of the client [113] without having to engage in formal disputation (D), and with the additional benefit of inspiring motivation (Seligman’s E – Energization) to work towards other more advantageous outcomes outside the isolated instance targeted by T-CBT.

This panoramic perspective facilitates improved outcomes via a strength-orientated lens that recognizes the positive in addition to the negative (both subjective determinations), and utilizes the exact science inherent in Dr. Barbara Fredrickson’s “Broaden-and-Build Theory”, which has shown that one’s ability to solve problems, think critically and creatively, flourish, and bounce back from adversity is enhanced in direct proportion to the amount of non-distorted (I.E., not manic or pathologically euphoric) positive emotion that they experience [115,116,117].

By calling to mind personal strengths and virtues that have enabled successful outcomes in their lives, individuals can broaden their “momentary thought-action repertoire” [115], or what is being isolated in T-CBT examination, and “build their enduring personal resources” [115] such as their sense of Agency and self-efficacy. These positive identifications can “enlarge the cognitive context” of a person’s perspective [75], allowing them to see past the narrow scope of an isolated belief informed by distorted thinking. The positive emotions resulting from these identifications are “efficient antidotes” to such beliefs [115], as they undo the lingering negative effects of a restricted viewpoint.

The promotion of positive outlook is necessary in order to achieve optimal outcomes in mental health treatment – not only because it aligns with the goals of NAMI, WHO, and NIH, but because “getting rid of unhappiness is not the same thing as achieving happiness… getting rid of weakness will not automatically maximize your strengths” ([72], p. 12). Bannink makes the point that therapists have become exceptionally good at “getting rid” of negative emotion, and Seligman agrees, having said with conviction that psychology has reached a station where it can successfully “make miserable people less miserable” [118]. However, Bannink notes that this has been the field’s reality for the last 30 years [71], and others believe this stagnation to be twice that long [67], leading to the natural conclusion that traditional cognitive methods and third wave therapeutic modalities have long since reached their peak of clinical innovation.

Enter P-CBT, which not only has the same utility in reducing symptoms of depression and anxiety as T-CBT [114, 119], perhaps due in part to its incorporated techniques of Solution Focused Brief Therapy [113], but with more enduring symptom reduction across time [113]. P-CBT also incorporates aspects of other efficacious PPIs such as using signature strengths in new ways, identifying idealized future goals, mindfully experiencing gratitude, and others that reliably promote self-reported experiences of enhanced well-being and life satisfaction [71, 82, 113]. So what exactly does P-CBT look like?

While T-CBT uses the “Downward Arrow Technique” to help clients identify the underlying Core Belief behind different automatic thoughts (“B” stage) in a process that winnows down the underlying meaning behind these thoughts with questions such as “If that’s true, so what? What’s so bad about… What’s the worst part about… What does that mean about you?” ([46], p. 207), P-CBT uses an “Upward Arrow Technique”. The Downward Arrow Technique is problem/deficit-centered, while the Upward Arrow Technique is possibility/opportunity-centered and seeks to identify positive reactions to a stressor, or “exceptions to the problem” ([72], p. 119).

In response to an adverse Activating Event, the Upward Arrow Technique asks clients “How would you like the situation/yourself/others to be different? What will be the best outcome? What will be the “best case scenario” here? And what difference will that make?” ([72], p. 120). Repeating these questions in response to each client answer results in more measured (undistorted) responses with enhanced perspective.

For demonstration, consider Fig. 1., which depicts a Football player who plays the position of Wide Receiver for his team. As time expired in a game with his school’s cross-town rival, he dropped what would have been the game-winning touchdown. In Fig. 1., both the Downward and Upward Arrow Techniques have therapeutic utility for the player, and are maximally effective in concert. In the Downward Arrow alone (T-CBT), his therapist is able to identify a belief that was held in the hours following the game—“I’m hopeless”—and this set the table for them to Socratically examine the belief and begin cognitive restructuring via CBT.

Fig. 1
figure 1

Downward arrow technique compared to upward arrow technique. Image rendered by Makenzie Pfeifer, RA—commissioned specifically for this article

Full size image

While this will optimally result in the player no longer feeling hopeless, there is a missed opportunity to foster Carol Dweck’s Growth Mindset, where he can recognize the drop as a paradoxically positive experience to inform future growth as a player. He is also denied the opportunity to analyze his abilities as a person through a broader lens, and acknowledge that any shortcoming is just one data point in the constellation of his experiences athletically, professionally, romantically, academically, and interpersonally, and does not represent the totality of who he is. Indeed, thinking of his engagement in these different settings may bring to mind more triumphs than shortcomings, allowing him to disqualify the Core Belief of “I’m hopeless” through positive, disconfirming associations. The Upward Arrow Technique allows him to broaden his perspective, and build his character through these realizations.

Notice that both techniques start with the same statement—“I dropped the game winning touchdown today”—with the Upward Arrow Technique allowing the player to identify that the “best outcome” or “best case scenario” of the dropped touchdown is that he can learn from his mistake, and continue helping his team win through his diligent effort, as he had done twice before that season. He acknowledges his ability to do so as the result of two virtuous strengths: being capable (Agency) and being coachable (able to integrate feedback, take instruction, and learn from past experiences).

Bannink notes that while we often think of happiness and unhappiness as being on the same continuum—just as one might think that languishing and flourishing would be part of the same spectrum—different tools are needed to reduce unhappiness and promote happy, eudaimonic flourishing [71]; a contention also endorsed by Seligman, as seen in a quote cited earlier ([69], p. 53). By combining the misery reducing techniques of Ellis and Beck’s cognitive modalities with the elevating strength promotion of Positive Psychology to form P-CBT, Bannink has created perhaps the closest manifestation to an operationalized version of Stoicism in our Anno Domini timeline. Indeed, Bannink mentions Zeno, Seneca, and Epictetus by name her book Post Traumatic Success [75], as she describes the Greek philosophic emphasis on simultaneously reducing misery and unhappiness while striving to attain “a happy, tranquil life, surrounded by friends and living self-sufficiently” ([76], p. 106]). Her modality has been empirically proven to achieve these ends [71, 75, 82, 113, 114, 119].

8 Conclusion: So what?

While the fields of Psychology and Clinical Social Work have reached their 4th Wave psychotherapeutic perspectives after an agonizing, multi-decade struggle with a disease based model of medicine, the Stoics acknowledged and exemplified these perspectives and practices thousands of years ago. If we had looked to their teachings sooner—or considered not only their emphasis on rationality and disputation as Ellis and Beck did, but also their emphasis on Eudaimonia and Agency as Seligman has—the field of psychology and its beneficiaries may have already had multiple decades of practice with this two-pronged approach. Moving forward, we would be best served to not try and reinvent the wheel with mental health, or contribute to what Robertson calls “the modern industrialization of psychotherapy” ([24], p. 9), in which we churn suffering individuals through a one-size-fits-all conveyor belt of problem-solving competency that leaves them less troubled, but no less empty or undeveloped as they navigate the complexities of life. How might a comprehensive, purposeful integration of Stoic teachings into therapist education and clinical practice be beneficial to our languishing twenty-first century clients? This is a question for the reader to answer through their work, research, and therapeutic engagement. P-CBT is certainly an intuitive place to start. This author hopes that the present article has served as a catalyst for such integration to take place.