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#149 – Tim LeBon on how altruistic perfectionism is self-defeating · 80,000 Hours Podcast

• Rob Wiblin: Hi listeners, this is The 80,000 Hours Podcast, where we have unusually in-depth conversations about the world’s most pressing problems, what you can do to solve them, and why it’s silly to cry over parts of life when the whole of it calls for tears. I’m Rob Wiblin, Head of Research at 80,000 Hours. I would bet an unusual number of people who listen to this show are perfectionists — in that they only feel good about themselves when they meet exceptionally high standards, even in cases where high standards aren’t warranted or helpful. Those might be standards for moral behaviour, or academic success, or alternatively professional accomplishment. Today’s guest, psychotherapist Tim LeBon, has provided therapy to some subscribers to this show who fit that description. He’s an unusual therapist because he did his thesis at Oxford on utilitarian moral philosophy and has published multiple books on Stoic philosophy. As Tim explains in a minute, while an intense desire to meet high and unvarying standards often comes from a good place, sooner or later it usually ends in disaster. It can make people feel miserable and sometimes leads to the development of depression or anxiety, especially after an external shock of some sort — and of course the whole time it can make people quite a lot less less likely to accomplish their goals. Have you been told that your standards are too high? Have you felt a failure as a person because you have not succeeded in meeting your goals? Have you raised your standards because you thought they were too easy? If that sounds relatable I strongly recommend listening to today’s episode. Tim and I talk about: How perfectionism is different from scrupulosity, or an OCD personality or just pursuing excellence What leads people to adopt a perfectionist mindset What pros and cons it offers people How 80,000 Hours contributes to perfectionism among some readers and listeners What Tim has learned helping perfectionists improve their lives What happens in a session of cognitive behavioural therapy for someone struggling with perfectionism and whether it helps patients or not Conducting experiments to test whether one’s core beliefs are true How exposure therapy for phobias works very well Distinguishing mental health and physical health problems How low-self esteem and imposter syndrome are related to perfectionism We then move on and talk about the philosophy known as Stoicism, which is much more than I had appreciated. We cover: Why the dichotomy of control is so important for maintaining calm What the ancient Stoics do better than utilitarian philosophers What’s good about being guided by virtues as opposed to pursuing good consequences How to tell which are the true virtues What the ancient Stoics got right from our point of view, and what they got wrong And whether Stoicism has a place in modern mental health practice If you’re interested to hear an episode of the show more focused on depression and anxiety directly, then I can strongly suggest checking out one of our most popular episodes ever: #100 – Having a successful career with depression, anxiety, and imposter syndrome All right, without further ado, I bring you Tim LeBon. Today, I’m speaking with Tim LeBon, a registered psychotherapist, accredited CBT therapist, life coach, and author who lives in Surrey in the UK. He’s written multiple books, including Wise Therapy, Stoicism: Cobwebs and Gems, and 365 Ways to Be More Stoic: A Day-by-day Guide to Practical Stoicism. Tim originally studied politics, philosophy, and economics at Oxford before doing a Master of Philosophy at the University of London. Today he lectures in positive psychology at City University of London, as well as offering cognitive behavioural therapy to both public and private patients. Most importantly for us, over the decades, he has provided therapy to a decent number of people who are trying to use their careers to solve the world’s most pressing problems, along the sorts of lines that we discuss here on the 80,000 Hours podcasts. He’s been trying to help them with issues like perfectionism, imposter syndrome, and anxiety. I’m super excited to be talking to Tim, because he’s pretty unique in his combination of understanding and being sympathetic to the worldview that I have, and that I guess we generally have on the show, while also being super knowledgeable about CBT, moral philosophy, Stoicism, and positive psychology, and having lessons that he wants to share, which he thinks might help people trying to do good both be happier and more productive. Thanks so much for coming on the podcast, Tim. Tim LeBon: Thank you, Rob, for inviting me. I’m absolutely thrilled to be here. Rob Wiblin: I hope we’re going to get to discuss what you’ve learned about perfectionism and how to manage it. But first, what are you working on at the moment and why do you think it’s important? Tim LeBon: Up until November last year, I was working pretty hard at my new book, which is 365 Ways to Be More Stoic. That might be a good place to start because the title is a slight misnomer. It’s actually 365 ways to be a better version of yourself, happier. It’s a synthesis of Stoicism and CBT and modern or positive psychology. So that was keeping me pretty busy last year. Now my typical day is that I’m a therapist, so Mondays and Tuesdays I work in the NHS in NHS talking therapies. That’s a wonderful thing: free therapy provided by the NHS. I’m a senior high-intensity therapist, which means I get to supervise other clinicians, do clinical work myself, organise some of the training, think about how best to prepare therapists to do their therapy, that kind of thing. The rest of the week, I’m in private practice and I do teaching as well. Rob Wiblin: Let’s waste no time in getting down to business, because in this interview we’re going to be talking about mental health and motivation issues that we think are disproportionately likely to affect the sorts of people who listen to this show or are busy reading lots of the 80,000 Hours website — at least relative to randomly chosen people. First off, we’re going to be thinking about perfectionism and different kinds of perfectionism. I know some of your patients over the years have identified as being involved in the effective altruism movement, and some of what you say is likely to be drawn from what you’ve learned working with those folks. But I’m sure a lot of people who don’t even know what effective altruism refers to will potentially recognise aspects of their own psychology in the discussion today. My impression is that the challenges we’re going to be talking about come up pretty often for people who have some combination of being smart and successful, as well as being quite conscientious or hardworking, and being very concerned with doing the right thing. Maybe also especially if they’ve embedded themselves in a group of people who are the same way and are also very concerned with trying to do good, and working hard, and being successful people. Just to sketch out the order of things so people have an idea of where we’re going: as you said, you’re a registered cognitive behavioural therapist, so we’re going to start by characterising perfectionism and talking about what core, fundamental advice you’d offer to someone who came to you because that was creating issues for them. Also, for a therapist, you’re in the top 1% probably in terms of knowledge of philosophy, and you have this side interest in Stoicism and positive psychology and so on. So later on we’ll turn to all of that, and also broaden our view to talk about challenges that listeners might potentially face beyond perfectionism. Sound good? Tim LeBon: Sounds like a good plan, Rob. Rob Wiblin: Brilliant. So could you describe the kinds of perfectionism that you’ve found in some clients focused on doing good with their careers? Tim LeBon: There is actually a rather tangled web here — that we’ll get to untangle if the listeners can be patient with us — of perfectionism, different types of perfectionism, low self-esteem, imposter syndrome, and something called moral perfectionism. So let’s start with perfectionism, shall we? Rob Wiblin: Yeah, let’s do it. Tim LeBon: First of all, it’s not a good name, “perfectionism.” Rob Wiblin: Why’s that? Tim LeBon: Because many people who are perfectionists don’t think they are. They will say things like, “But I’m not perfect.” What we’re talking of here is someone who has very high standards, but it’s not just that — because there’s such a thing as “functional perfectionism,” which is someone who has very high standards, and reaches them, and lives a happy life. You might say to me, “Tim, what’s the problem?” And the answer is, there is no problem. What we’re talking about here is dysfunctional perfectionism, or someone who has standards that are some combination of unfeasibly high and unsustainable — and it actually impedes their functioning and is very often self-defeating. Rob Wiblin: So is that the core issue? Just that the standards in absolute terms are extremely difficult for them to reach, or at least to reach consistently? Tim LeBon: That’s one of them, certainly. One is that the standards are just too high or too inflexible or unsustainable. A second feature is that people often think that if they don’t attain those standards, something really bad will happen. For instance, people will shun them, or they’ll get the sack, or they will just be no good as a person. So, in other words, another feature of general perfectionism — technically the name for it is “clinical perfectionism” — is that people tend to put too many of their eggs in the achievement basket. Think of someone who is a workaholic. It could be any career. It could be someone working in the city, could be a doctor, could be a teacher. This person might be doing something valuable or they might not be doing something valuable, but they’re putting all of their eggs in the achievement basket. That’s what they identify as: I am a teacher or banker. They might work ridiculous hours, do not so much self-care and relaxation and fun as most other people. And they might have periods where they’re doing very well. Obviously there might be a lot of fringe benefits: you’re doing very well, you’re earning all this money, you’ve got promoted. But eventually, well, usually — if they come to see someone like me — it means there’s been a problem. That problem could be that they burnt out or their relationships have suffered. We sometimes call that the “crash and burn” or the “boom and bust” cycle. They can well have problems with anxiety or depression, although underlying in that case would be clinical perfectionism. I don’t know if that makes any sense. I don’t know if you know anyone like that, perhaps. Rob Wiblin: I’ve lived long enough to know a few. OK, those three big traits are: there’s the standards that are high in absolute terms, and very challenging to consistently meet. Then there’s maybe an inflated sense of the terrible negative consequences that might happen if you fail to meet these very high standards. I suppose related to that is putting a lot of your identity, or your positive self-image, maybe exclusively pinning it on this sort of professional success. You might have a professional setback, but nonetheless, you’re treating your family very well or your friends really appreciate you — but you don’t care about those things. It would still be a crushing blow to your self-image. Tim LeBon: Absolutely. Rob Wiblin: It seems to me like there’s two different classes of perfectionism that I’ve seen out there. One is this thing where you really don’t want to submit a piece of work or publish something — the one that I’ve seen the most in the content production business — because you’re very worried that it’s not quite good enough and people are going to pull it apart. You kind of delay finishing or delay delivering things, or maybe even delay starting them because you think you’re never going to get it up to a perfect level. Then there’s this other thing — which seems related, but not quite identical — where people beat themselves up all the time, or they’re constantly having thoughts about how they should be living more morally. Whenever they take time off, they feel like, “Well, I should be working.” Whenever they spend money on themselves, they think, “Maybe I should give that money to charity.” I suppose environmentalists sometimes have a flavour of this as well, where they feel any consumption that they engage in is harming the planet and they potentially feel guilty about that. Would you say these are two sides of the same coin? Or what’s the relationship between these, if you would distinguish them as well? Tim LeBon: I think perhaps the second type would be moral perfectionism. I would say that is a subtype of clinical perfectionism. And very often people might have both. It looks exactly like what you said. But what do those two types of perfectionism share? They’ve got probably all those three criteria that you mentioned earlier: putting most of your identity eggs in one basket, having high and inflexible and unsustainable standards, and also fear of what happens if they don’t reach those standards. Now, with the general clinical perfectionism case, it’s usually just to do with achievement in general. I forgot about the academics. Academics could well fit into this category, as well as the jobs that I described. You could have an academic who procrastinates — procrastination is another very common feature of this type of person who worries a lot. They can get into a cycle where they have this very high standard. There’s a trigger, like someone suggests, “Why don’t you go for this publication?” or “Why don’t you write this book?” or “Why don’t you finish this dissertation?” or something. I think it can happen to people doing PhDs, for instance. They might turn it down because they see it as such a big mountain to climb that they don’t even try it. So avoidance is one thing they can do. They might ebb and flow in their motivation: “Yes, I will do it.” “No, what a terrible mistake. No, I won’t.” That’s procrastination; they might just take a huge amount of time over it. They also might not seek feedback from others because they’re frightened of failure. You can see how this might play out in, for instance, someone writing a PhD or not writing a PhD. That’s general or clinical perfectionism. And then the subtype of it we’re calling “moral perfectionism” today: it’s the term that I started to use because I started to see these types of people. Very often they’re effective altruists; there are one or two who weren’t. And when I looked it up in the literature, there is such a thing as moral perfectionism, but it’s not very well researched or documented. So what is this moral perfectionism? It would be very similar, except instead of focusing just on achievement, it would be focusing on your moral worth: your identity is linked with how good you are as a person. The standards would again be unfeasibly high and inflexible. Maybe something like “doing the most good you can” — to coin a phrase — every moment of the day. Rob Wiblin: Hypothetically. Sounds tough. Tim LeBon: It does sound very tough. So you’d worry about not doing it. You would procrastinate. You might even avoid some tasks, because you avoid being in the public glare because you fear you might fail. If then you didn’t succeed, or you thought you hadn’t succeeded in reaching that target — which of course you won’t, because it’s such a tough target, and sometimes you won’t succeed in having a really fantastic outcome in everything you do — then you’ll be very harsh. Harsh self-criticism. And very often, a result of that is shame. And shame — I’m sure there are lots of listeners out there who’ve listened to Brené Brown and similar TED talks and writings — shame is one of the least constructive emotions. Guilt can be quite a useful emotion, but shame is where you just feel like hiding away. Very often you just feel like escaping, so you don’t get help. You’re just left with this feeling of very often self-hatred, self-loathing — because remember, your whole identity is wrapped up with being this really good person. You’ve set yourself an incredibly high, unfeasible standard to do that. You haven’t achieved it. And so you’re just left there on your own, thinking that you failed and that you’re a terrible person. So that would be moral perfectionism. I don’t know if that makes sense at all. Rob Wiblin: Yeah, completely. You could see how this could be both an intoxicating mix to start with, and also creates a positive feedback loop that can get people into serious trouble — where feeling ashamed and feeling terrible about yourself is not super conducive to then going and working really hard. Or at least a lot of the time that’s going to be an impediment to reaching those standards, because you’re just having negative thoughts all the time and worrying that you’re not going to meet the standards, and then maybe actually will stop even reaching ordinary people’s standards. You’re stuck in this negative feedback loop of negative self-image and not being able to act and so on. Tim LeBon: That’s exactly it, yeah. So depression and anxiety, sometimes at clinical levels, can come out of the bottom of this. Then, as you said, once you’re in that, it’s actually very hard to just reach the normal standards. Then that would go back to saying, “Oh god, I really am such a terrible person,” because people like that tend to also have a very high sense of responsibility and tend not to make allowances for themselves. And then as I said, if they also are full of shame, they won’t actually get positive feedback from other people so much because they’re hiding it. So it’s a really difficult mixture. Rob Wiblin: What’s distinctive about treating people with this issue as opposed to other mental health issues that people come to you with? Tim LeBon: I have to say — and not just because some of them might be listening — that it is a pleasure to work with people who identify as effective altruists, and that includes many of them who might be perfectionists. And why is that? It’s because they’re bright, they’re conscientious, they’re super motivated, and they’re generally nice people. What you’ve got is people who are super motivated with a real problem. We’re not just talking about people who are just having therapy as a luxury — this is something that can very often cause clinical levels of depression and anxiety, and stop them doing what is most important to them, which is making a positive impact on the world. So I enjoy working with effective altruists — and of course, from my own perspective, if I do help them, then it means I’m helping people who will then go on to do a lot of good. That’s another little benefit. Rob Wiblin: Yeah, nice. Do people generally benefit from therapy? Do they generally see substantial improvements in how much perfectionism is impeding their life? Tim LeBon: That is a very difficult question to answer. What I would say is it probably depends to a large extent on a number of things. One is whether people really identify themselves in the model. I need to say a little now about what CBT involves. Rob Wiblin: Yeah, go for it. Tim LeBon: Often people think CBT is just a boxload of techniques and tricks. And it has got a boxload of tricks and techniques and tools. But that’s not really what CBT is. CBT is where you first of all try and understand the problem: to identify the problem — in this case, perfectionism — then try and understand it. Lots of researchers have tried to create a general map for common psychological problems like depression, anxiety, perfectionism, and low self-esteem. And a whole host of other ones, like OCD, social anxiety, and body dysmorphia, and all kinds of things. So researchers go and create what we could think of as a general map. So if I’m assessing someone in the first session, I’ll be asking them questions which might seem a bit random. For instance, if someone came who said, “I think I might be a perfectionist,” I’d be asking them about their standards, I’d be asking them about whether they procrastinate, I’d be asking them about what happens if they don’t meet their standards. Those questions would be drawing from the generalised map of what people who are perfectionists tend to do. And then what we do is we create a customised map of their perfectionism, if it is perfectionism. Sometimes it’s a mixture of perfectionism and something else. We try and work out exactly what’s going on for them. Very often we’ll draw diagrams. Very often it involves them keeping diaries and logging what’s actually happening. When they say, “Oh yeah, we’ve got it — that’s me,” then we go on to the active treatments phase, which is trying to target the processes that keep this problem going. Just to give one example, if someone’s very critical of themselves, we might introduce them to self-compassion. It involves a lot of things, doesn’t it? It involves, first of all, someone turning up regularly — which, if someone’s very distressed, might be very challenging. It means that they buy into this way of looking at things, which not everybody does. And they’ve got to be able to collaborate in therapy, because you’re working together with them. I often say, “I know a fair amount about psychology, but you know about yourself, so we’re going to piece it together like scientists and try and understand it.” And then they’ve got to go and do the stuff between sessions, which is a really important part. To come back to your question as to what are the chances of success, I would say doing homework — I hate the word “homework”; I tend to call it “home practice” — doing the home practice is probably the best indicator of success in therapy. Rob Wiblin: Yeah, that makes sense. You mentioned that many people come in with this cluster of issues — I guess identifying that something is not going great in their life, but they don’t necessarily think of themselves as perfectionists. Are there any who do? Or is it hard to persuade people that they have perfectionism if they’re reluctant to think that? Do you think it’s your place to try to persuade people to see their life that way if they don’t view themselves as having this issue? Tim LeBon: I think there’s the word “perfectionism” to get over. And if they haven’t said they were a perfectionist, but they talk about some of these maintaining processes happening — which would be things like, “Often people tell me that I set the bar too high” and “Sometimes I procrastinate” and “I’m quite harsh with myself when I don’t meet them” — then you’d be picking up possible clinical perfectionism. And there would be a discussion about whether this was a good thing or not. Very often an important phase very early on in therapy for perfectionism is the pros and cons of their current way of being. Sometimes we draw out a little table of perfectionism versus excellence, because they’re not the same thing. Perfectionism is aiming at something perfect, and search for excellence is something excellent — they’re not quite the same thing. Rob Wiblin: One of those is more achievable. Tim LeBon: One of them is more achievable. Perfection would be something that was very subjective as well, and ultimately unattainable, whereas excellence is something that you can have certain skills and you can train yourself to achieve it. You can say, “Which would you rather go for? All this stuff on the left-hand column, which is the perfection stuff, which is generally unattainable? Or this stuff on the right-hand column, which is excellence?” Generally they would say, “Yeah, let’s go for excellence.” Then you’re kind of getting people to understand that it might be the search for perfection that’s the problem. Because what people don’t want to be is mediocre. They’re saying, “Tim, you just want me to be rubbish? I know X, Y and Z who just don’t do anything. They waste their lives. Do you want me to be like that?” They don’t say that usually, because they’re too polite, but you see that in their body language. It’s not even necessarily about lowering your standards that much; as I said, it’s about standards perhaps being more flexible and attainable. So for instance, if someone has a physical health condition, then it wouldn’t be fair to then assume that they can reach the same standards, do the same things as they would if they didn’t have it. Rob Wiblin: Or just always be hitting the same level, regardless of how their physical health issue is going. Tim LeBon: Exactly. Rob Wiblin: Do perfectionists have high standards for other people? For their colleagues and so on? Tim LeBon: Great question. There’s such a thing called obsessive-compulsive personality disorder — which is another very confusing term, because it’s not the same as obsessive-compulsive disorder, but it does share to some extent a concern with orderliness. Anyway, these people with the OCD personality have unrelenting standards about other people. If someone’s got a boss like that or a partner like that, then that is bad news. Rob Wiblin: Challenging for other people, I suppose, as well as them. Tim LeBon: It’s less common for people to recognise that in themselves. I have worked with people with that problem. I can think of one lady I worked with who just was very tearful that she’d realised that this was how she was, and she was very motivated to try and change it. There’s various ways that people can approach that, but one would be to recognise that their rules don’t have to be rules for other people. That could be a really big insight: “These are just my rules, and it’s not fair for me to expect everyone…” Or they might say, “I can’t expect everyone to be at my level,” which would be a certain way as well. Rob Wiblin: Maybe meet them halfway. Tim LeBon: Yeah. Rob Wiblin: Would you classify that as kind of a different issue? I guess my impression of people who have very high standards for themselves is that often they don’t have particularly high standards for other people. It’s very self-focused, or they can be very nice about other people — maybe even quite self-effacing in some ways, and not especially demanding. It’s like it’s something about the attitude towards their own work in particular that’s creating the issue. Tim LeBon: I think the vast majority of people in the effective altruist movement would be exactly that kind of person you’ve described, who have a double standard. So we can use that in therapy: “Haven’t you got a double standard? What would you say if a friend who was ill didn’t manage to put in their assignment?” Or whatever. And they say, “Well, of course it would be fine.” “And what are you saying about yourself? ‘Oh, it’s terrible.'” So that can help, just to take a different perspective. Rob Wiblin: Have you noticed any patterns? Or maybe do people in the literature know of any patterns? What are the reasons that some people end up having this kind of worldview or this attitude, and other people don’t at all? Do we understand the drivers? Tim LeBon: No is the short answer. And the stock answer, which I can give you, is that it’s a combination of genetics and upbringing and what happens in your current environment — which is where we might get onto the effective altruism environment as possibly sometimes a contributor to this. So it is a bit of a pat answer, really. But one thing we could say is about parenting style. If there are any parents out there, then if you want to bring up someone who has these problems, this is what you should do: First of all, tell them that all that matters is success — that’s all that matters in life. You should also say that it’s the results that matter; there’s no excuse for not succeeding. If they get 90% and came second in their class, what you have to say to them is, “Who came first? Why can’t you be like them?” Obviously, I do meet people in therapy who’ve had that kind of parenting. Joking apart, because I don’t want to trivialise it: if you’ve had that message as a child, it’s quite ingrained. Rob Wiblin: You just end up with that voice in your head, basically. Tim LeBon: Yeah. “It’s not good enough. You’re rubbish. You’ve got to get 100% or failure.” Rob Wiblin: Speaking of the way people talk to themselves, what classic lines do people have in their head when they’re engaging in this thinking pattern? Are there any particular classic sentences that people are repeating to themselves that are generating this? I was thinking in part maybe someone could recognise themselves in this, if they’re thinking this particular thought recurrently. Is there anything maybe we’ve already mentioned, the main ones? Tim LeBon: Some people even recognise the tone of voice rather than the content. They would say, “Gosh, that’s my mother speaking,” or “That’s my father speaking,” or “That’s that teacher.” But it would kind of be, “You’ve got to always succeed. There’s no excuse for failure” — “no excuse” would be perhaps something that might come up a lot. I think if people have had that kind of upbringing, they will probably recognise themselves. Rob Wiblin: Do you think your clients are more inclined to listen to you because you have this background in philosophy? You did a thesis on something to do with utilitarianism, if I recall. I suppose all different moral philosophies could lead to this style of thinking. It seems like consequentialist moral philosophy is maybe particularly inclined to this perfectionist issue because of its kind of maximising element. Tim LeBon: In fairness to utilitarianism, we need to point out that Chidi Anagonye of The Good Place is probably a prime fictional example of moral perfectionism. No spoilers, because I think this happens in a very early episode of The Good Place — which, if you haven’t watched, then I do recommend it. But he’s told that Eleanor is his soulmate, and so she says, “Will you do anything for me?” He says, “Yes, of course I will.” She tells him that she shouldn’t be in the Good Place, and so he has to lie. He’s a deontologist and so he gets stomach ache — “Oh, no, what do I do? I’ve got two things: I’ve got to lie to Eleanor, or I’ve got to lie to other people about Eleanor.” That’s just saying it’s not just utilitarianism that can suffer from this particular problem. But to come back to your question, I studied PPE — philosophy, politics, and economics — at Oxford. I didn’t know any philosophy, and I just did it because my history teacher had said, “Tim, you like history and you like economics. There’s this thing called PPE. You can drop philosophy after the first year.” And philosophy came to be… I was going to say “love of my life,” but my children and wife might not forgive me. Rob Wiblin: Intellectual love. Tim LeBon: My intellectual love, yes. We did John Stuart Mill and utilitarianism in the first year, and I just thought, “Wow.” Obviously when you’re doing that, you come across all the problems that there might be in utilitarianism. But the basic idea — that happiness matters, that suffering matters, and that we should think about consequences rather than some (what seemed to me) random rules — it just made so much sense. I really got into philosophy in general, but particularly ethics and particularly utilitarianism. I went on to do an MPhil, actually, on R. M. Hare, a now probably pretty obscure philosopher — but at the time, he was rock and roll. He was a thing. Rob Wiblin: I’ve heard of him, yeah. It sounds like a lot of your clients are pretty bright people, and they could potentially argue back quite convincingly or come up with strong reasons why they should continue to think the way that they do. I wonder whether having a deeper understanding of where they’re coming from, philosophically, maybe could be quite central in being able to have the empathy to understand why someone has the philosophy that they do, in order to potentially get them to think differently. Tim LeBon: I think that is the case. My worry would be that some therapists would just treat all this as intellectualising: either they wouldn’t understand it, or they would just consider that it’s not to be taken seriously and they would be very dismissive of it. Partly because I’ve got a philosophical background and partly because I’m basically sympathetic to utilitarianism, I think people do appreciate that. Rob Wiblin: Yeah. To give it its due, what could you say in defence of perfectionism, in a sense? I mean, people aren’t arriving in this place for no reason whatsoever. There are often good intentions, or partially good ideas, I think, behind it. Tim LeBon: Yeah. But you know what they say about good intentions. You might say the road to depression and anxiety. There’s a CBT therapist called Christine Padesky who says everyone does things for good reasons. And I love that. I think, as a therapist, that’s what one is trying to do: one is trying to understand why people are doing this. Well, certainly there will be some payoff, as we said earlier: they’ll get praise, they might get rewards, and also sometimes they’re going to hit the goal and that’ll feel really great. And they might have this positive identity as a high achiever, so it’s not just the toxic parents and the toxic genes. But that’s assuming that they get into functional perfectionism. I think by its very nature, when it becomes unsustainable or inflexible, then it’s going to be more dysfunctional. Rob Wiblin: It’s fragile. It’s maybe always going to be riding the line between something that’s working now, but some kind of shock could perturb you. Like if you get sick and then you can’t do things, then you’ve set up this positive feedback loop where you can potentially become quite unhappy. Tim LeBon: Yeah, exactly. And with moral perfectionism — which, as we said, is having a lot of your identity in being a very good person and having very high standards — again, there will be payoffs, won’t there? You’ll be thought to be perhaps a role model for people, probably be thought to be a very good person. And you actually will be very conscientious. There are certainly good reasons to aspire to have higher-than-average standards in terms of achievement and in terms of what you do morally. So that is to give its due. But… Rob Wiblin: OK, let’s push on from describing and understanding perfectionism to talk about what sort of advice and assistance you can potentially offer people who come to you, saying, “This isn’t working out for me so well anymore.” You’re trying a couple of different approaches, or I guess “modalities” — is that the technical term? — different ways of helping people who are having mental health issues. But the main approach you use is cognitive behavioural therapy. Why is that the one that you turn to most often, or that you most often find yourself using? Tim LeBon: I think the best answer I can give is that it’s the most evidence-based one. But there’s also, to be honest, an element where it probably appeals to me as someone that’s quite logical and a problem solver. I like working with structure. I initially trained as a counsellor, where it’s a much more open-ended “Tell me about what’s wrong,” and you listen and are empathic. And I found two things. One was that people didn’t improve as much as I hoped, but also they didn’t improve as much as they hoped. Also I found it quite frustrating, because I’d think, “There must be more that I can do.” CBT is a very active therapy. It’s very active. You’re trying to understand the problem, and you’re trying to take steps to alleviate it. So there’s a theoretical answer, which is: it works — with asterisk qualifications: it doesn’t work for everyone, isn’t the best treatment for every single condition, et cetera. And also, I think it suits my personality and my particular skill set. Rob Wiblin: Yeah. I suppose if it fits your personality, it might well fit the personality of the kind of people you’re clicking with, who you’re having chemistry with. Tim LeBon: Exactly. Rob Wiblin: I think many listeners will have heard of cognitive behavioural therapy, and have some idea of what it is. And probably many people have done it. I’ve been through a CBT workbook before. For those who aren’t so familiar, is there a way of summarising what it is in a nutshell? Tim LeBon: Well, it’s partially what’s written on the tin: it’s cognitive, which means it’s to do with how we’re thinking about things, and it’s behavioural, which means it’s to do with what we do and what we don’t do. Let’s take a different example of someone who’s depressed. I say “different,” although depression can often feature in perfectionism and moral perfectionism. Someone who’s depressed might just realise that they’re not their usual selves. They might have low energy, they might lose motivation, might not feel like doing anything. And they might present themselves to a doctor. The doctor might say, “You’ve got a choice of medication, or you might want to try some therapy. Why don’t you try CBT?” You come along to a CBT therapist. As I said earlier when I was talking about perfectionism, you do some questionnaires. That’s another important part of CBT: to try and get a baseline for where they are. You try to do that kind of map of what’s going on for them. You’d probably get them to do some diaries. And then for depression, actually, you’d probably go with the behavioural bit more than the cognitive bit to start with — because if you’re in a very deep funk, it’s very often hard to just think yourself out of it. If you’re painting everything black, then it will stay black, really, no matter what the therapist says. Very often you need to kickstart it by getting some positive feedback from the world. If someone came in for depression, probably what the therapist might ask you to do is something called “behavioural activation,” which means get active: even though you don’t feel like it, go out, start speaking to people, take very small steps, do things. One idea is that action comes before motivation very often, rather than after it. Don’t wait for the motivation bus to come. Those would be the kind of things. And then when someone started to interact with the world a bit more, then they might start to feel better, and then you might do some cognitive work on them as well. Rob Wiblin: So, cognitions in therapy, they’re like particular things that you say to yourself? That’s what a “cognition” means? Tim LeBon: There are different layers of cognitions. So there’s something called “automatic negative thoughts,” which might be, you’re driving along and someone beeps their horn at you, and you might have an automatic negative thought, which we probably can’t repeat on air. It would turn the airways blue. That would be automatic negative thought: the thought that runs through your mind. There’s a second layer of cognitions, which are called “assumptions” or “rules for living.” They’re not quite the same, but they’re in the same category, which might be, “People should respect me.” So if you’ve got the rule “People should respect me,” or the assumption that “People should drive without beeping their horns at the least little excuse,” then you’re more likely to have that negative automatic thought. In other words, that’s going to a deeper level. And then the deepest level still are what are called “core beliefs.” Which can be core beliefs about yourself: someone with low self-esteem might have a core belief of “I’m not good enough.” Someone with moral perfectionism might have a core belief — actually it’s possibly more an assumption or a rule — but it would be something like, “I’ve got to do the most good I can, and people will shun me and criticise me harshly if I don’t do the most good I can.” So that’s three levels. And very often as a therapist, you’re working at the top level — the automatic negative thoughts — to start with, because those are the easiest to change, the easiest to detect. Well, they’re actually not easy to detect, but certainly the easiest to change, and sometimes that’s all people need. But then with the more personality-related problems… So there are things called “personality disorders,” but I see perfectionism and low self-esteem as “personality-related issues,” because it’s not just one day you’re a bit perfectionist and the next day you’re not. It’s kind of a trait, a personality trait. And there you tend to be having to work not just with the automatic thoughts, but with the assumptions and sometimes the core beliefs. And so it can take quite a bit longer. Rob Wiblin: I see. So you have behaviours, they’re very visible, and then you’ve got thoughts at the surface level of what’s going on in the head, and then there’s beliefs underneath that are generating the thoughts, potentially. I suppose maybe even deeper assumptions underneath all of that as well. Tim LeBon: Absolutely, yeah. Rob Wiblin: Normally we think that thoughts generate behaviour, whereas it sounds like the rule of thumb in a lot of these treatments is that behaviour can generate thoughts. You’d normally think it might be easier to first decide that going for a walk might be nice, and then go for a walk. But actually, in fact going might be easier — to just go for a walk, regardless of what you think, and then find that actually it was fine. Things don’t have to necessarily be that way, but it seems like they are. Tim LeBon: Yeah. In CBT, there’s a model called a Five Areas model, or sometimes called a Hot Cross Bun, because it looks like a hot cross bun. To complicate things a bit more, it has cognitions (or thinking) and behaviours on two cogs, if you like, but it also has emotions, and the body or physiology, and the situation. Those are the five areas, and the idea is that they all influence each other, they all interact. So that very simple model of just “thoughts causing behaviour” can sometimes be true — and it can be a very important causal direction to work on — but we train a CBT therapist to be alive to the fact that it could be that you can change it by targeting any of the others. Of course, with the body that might be by medication, which wouldn’t be a therapist’s role. But some people respond very well to medication. Or it might be things like exercise. And with the environment, for instance, in a very toxic relationship, someone might just need to get out of that relationship — and, hey presto, their life will improve enormously. Rob Wiblin: Yeah, completely. OK, let’s maybe now imagine a hypothetical CBT session that you might do with someone who was having these classic issues with perfectionism, say, in their work. How would you start a session? What things might you ask early on in order to understand what’s going on? Tim LeBon: As I mentioned, CBT is structured. So generally there’d be a very brief “How are you?” Generally, that would only take a couple of minutes, but sometimes something would emerge there that would then go onto the agenda. Because then what one does is have an agenda for the meeting. It’s quite businesslike in a way. It’s that strange combination of being very businesslike, but also very personal and hopefully empathic as well. So I’d probably say, “Hi, Rob. How was your week? OK, so what should we put on our agenda for today?” We might have a standing item, which is to review the home practice, which is the target therapy task you’ve had that week. I’d say, “I’m super interested in how you got on with that task you were doing. So it was perfectionism: Your task last week, if I remember rightly, was to deliberately send an email with a mistake in it because you’ve got very high standards about grammar. We agreed, didn’t we, that you were going to send a non-important email — not one to your most important client, but just an email — that, say, has a grammatical error. Did you do it?” “Yes, I did.” “OK, I’m super interested to see what we can learn from that.” And then I might say, “What else would you like to put on the agenda, Rob?” When people are super engaged with therapy, then they’ll have a list of one or two items. But to start with, very often it’s me saying, “So what’s happening next week? Is there anything relevant to what we’re talking about happening?” That’ll be a cue to say, “Oh, yeah, I’m giving this presentation in two days’ time.” “OK, is that relevant to your social anxiety or perfectionism? So should we talk about that?” So agenda-setting, and then you’re working through the agenda, which would be looking at the home practice, and what we can learn from it together. We might be looking at that map that I was talking about of your issue, which is technically called “the formulation.” We also have therapy goals — which I would ask the client for before the first session, probably — and then we’d be reviewing them: “Where are you out of 10 on those? Are these still the relevant goals for you? Should we be looking at any of those today?” So we will be working through only about two or three things on the agenda, but then we make sure to set home practice for next week, and then do a fair amount of summarising and checking that we’re on track during the session. So it’s got a very clear structure. I should also add that there’s a mix of guided discovery or Socratic questioning, which means you’re not telling the client something; you’re helping them learn from the experience. So let’s go to that: it’s called a “behavioural experiment.” The behavioural experiment that this client set was to deliberately have a spelling mistake in a couple of emails. And so: “Did you do it?” “Yes.” “What happened?” “Well, I did it and I was nervous, but then nobody seemed to notice.” “Nobody noticed. So how did you feel then?” “Well, maybe it doesn’t matter so much.” “So what do we learn from that?” “Maybe I don’t have to spend 20 minutes checking every email so much.” That’s guided discovery. Because you could straight out go and tell someone, “Oh, I never bother to check my emails to see whether anyone’s made a mistake, so stop checking.” But if I did that, how would you feel? If I lectured you like that, how would you most likely feel? Rob Wiblin: Maybe irritated. Or not convinced, anyway. Tim LeBon: Exactly. There’d be some resistance. Whereas if it’s set up as an experiment, there’s two benefits. One is you’re discovering it for yourself. The other thing, which is beautiful about cognitive behavioural therapy, is that sometimes there’s an unexpected outcome. Now, suppose this person comes back and says, “Why did you tell me to do that, Tim? My boss was furious with me.” Well, that’s not a great outcome, because you don’t want the boss to be furious with them. But you’ve learned something: you learned that their boss is possibly someone with that OCD personality we were talking about — and so there is a reality to their precautions. Rob Wiblin: And maybe that’s how they’ve ended up with this concern. Tim LeBon: Possibly. It might be that that’s true of the whole workplace. Absolutely. So you try and do a lot of that guided discovery. But there is a place as well for what’s called “didactic.” Which might be, for instance, if you’re teaching someone a relaxation exercise. You can do it kind of socratically, and say things like, “How do you relax? What’s your best way of relaxing? Why don’t you try that again?” The problem might be that someone just hasn’t got that skill in their kit bag. So there’s certainly a place for saying something like, “Do you think that a relaxation exercise would be useful before you’re doing this big presentation?” If they said yes, you’d say, “Well, there’s a couple you might choose from. There’s guided relaxation, there’s breathing, there’s something called progressive muscle relaxation. Have you ever tried any of those?” They might say, “Yeah, I tried the progressive muscle relaxation. I didn’t like it.” “OK, so should we try one of the other two?” And you probably try in session, and then see how they got on, do a little bit of coaching to help them. Then the home practice might be to do that breathing exercise every day, for example. Rob Wiblin: Right. It sounds like it’s pretty exercise- and action-focused. You were saying it’s the follow-through on doing those experiments that’s particularly valuable, or particularly predictive of people feeling better. What are some other exercises that people might do? Are there other classic ones other than making a mistake and then seeing what happens? Tim LeBon: Surveys are a good one. For example, someone who thinks that their relationship isn’t good enough, or they’re not a good enough partner, might ask their friends about their relationships. And they might discover that actually, relationships which they’ve thought of as being perfect, it turns out that “We don’t spend all our time together” or “We do argue sometimes.” Now, there is a particular issue there with moral perfectionism and effective altruists. Because if you’re in an organisation where a lot of your colleagues have got very high moral standards and buy into doing “the most good you can,” then it might be problematic doing the survey. Rob Wiblin: It’s like, “Do you think that people should always do the absolute best thing?” And they’ll be like, “Well, yes, obviously.” Tim LeBon: And of course, it might be that people secretly are kind of not sure that they can reach that standard, but they’d be in their shame world perhaps, putting on that public image. So you can see you could get into quite a lot of difficulties when your peer group has actually subscribed to the unrelenting, unfeasible standards. First of all, because you’d be worried about them criticising you, but also one of those techniques like the survey would actually then potentially backfire. Rob Wiblin: Right, I suppose directly backfire. But then you might also have learned what is generating this, or what is making it very difficult for someone. Tim LeBon: That’s true. You learn from any experiment. So we’ve got experiments, we’ve got surveys. Then there’s something called “cognitive restructuring,” is the posh word for it, which is working at the level of automatic thoughts — whereby you notice your automatic thoughts, and you ask yourself questions like, “Is this a fact or is it just an opinion? What would they say in a court of law about it?” For instance, suppose I’ve had a client session, and I think that it wasn’t a very good session. Then if I was doing a kind of cognitive restructuring, I would say, “Well, that’s just my opinion. It’s not a fact.” And then, associated with that, there are all these lovely thinking traps that therapists have noticed, such as jumping to conclusions; double standards, which we mentioned earlier; and fortune telling. Rob Wiblin: What’s that? Tim LeBon: Fortune telling is where I think I know what’s going to happen, but actually I’m fortune telling. Rob Wiblin: You’re making a forecast but imagining that it’s for sure? Tim LeBon: Yes, exactly. And then overgeneralising: something has happened in the past, so I assume it’s always going to happen in the future. Black-and-white thinking or all-or-nothing thinking — which is a favourite one of perfectionists and moral perfectionists — which is exactly what we were talking about earlier, about if you haven’t got 100%, it’s awful. So 90% is as bad as 0%. Discounting the positive and exaggerating the negative. You can teach people what these thinking traps are, and then perhaps they’ll identify with a few of them, or sometimes all of them. Then the homework might be to notice them doing it. For instance: “I’d like you to keep a record of when you jump to conclusions.” The next stage might be to come up with an alternative, which would be to look at the evidence. One of my favourite tools is called STOPP, which puts a number of these things together. Sometimes I would introduce it to people in very small stages because it can be a bit overwhelming, but it’s very nice. STOPP is an acronym: You Stop. You Take a moment, Take a breath — that’s the T, and that’s a bit of mindfulness. We haven’t mentioned mindfulness yet, but that can be a part of treatment. Sometimes just in a very basic sense, where you’re just aware — you just notice what’s going on, you notice you’re thinking. So you’ve Stopped, you’ve Taken a moment, you’ve kind of Taken a step back as well. Then you Observe — that’s the O: you observe your thinking, the automatic thoughts, perhaps the assumptions as well. You also observe your emotions. For instance, let’s go back to that road rage example. They’re driving along, someone’s horned them. And so they might Stop. Take a moment, breathe — which would actually calm them down, apart from help them be more detached from things. Observe their thinking: “That person should respect me.” The next, P, is to get a different Perspective, which might be challenging the assumptions that one’s making. Maybe that person is in a hurry because they’re on the way to the hospital, for instance. Or maybe that person is just having a really bad day. You try to come up with a more helpful perspective — and there can be quite a lot more to unravelling what that helpful perspective might be. The last P is Practicing what works. You’re getting into problem-solving there, given that realistic perspective, which might be, “That person could well be having a bad day, or maybe they’re on the way to the hospital. In any case, what’s the point in me getting angry? Let dangerous drivers take their accidents elsewhere.” Practice what works might be just to say to yourself, “Oh well, poor chap.” Rob Wiblin: Thinking for a moment about where this might fail to help, or what would be the barriers to this actually helping someone get over their perfectionism. Someone does this experiment, where they send an email where they have errors in it and then see the reaction. Someone who had a very strong perfectionist mindset might think, “Well, no one wrote back abusing me for the error, but they thought that I was an idiot probably, and they simply were too polite to say anything. And the consequences will be down the road.” Or if you did a survey and asked people directly, “Do you expect people to always finish things to deadline? Do you expect them to be at this standard?” And then they say no, but you might think, “Maybe they’re just being polite. They’re refusing to tell the truth and say how badly they feel about me.” Tim LeBon: That’s why CBT is such fun, Rob, because what you do in the session — and this is particularly fun if you’ve got a really engaged client who’s really into it — is really try and work out what belief it is you’re testing and what will count as evidence. A bad behaviour experiment would be for the therapist just to say, “What I want you to do is to write a letter with some mistakes in it, and that will prove that it doesn’t matter.” And If anyone’s listening who’s heard me do that, I apologise. Because sometimes when we’re pushed for time, we don’t necessarily do the thing that we’d recommend the therapist does. But ideally what you do is you would set up quite a lot of time to set up the experiment. You’d say, “What is the problematic belief?” Remember, you’ve got your map — in this case your map of perfectionism, which might have that element, which is, “Other people are going to be very punitive if I don’t achieve these very high standards.” And then you might say, “How do you think we might test that out? What is there in your life? What do you do at the moment that assumes that is true?” They might come up with their own example of what that might be. It might be something else, like, “I’m having a dinner party at the weekend, and I’m planning to ask everybody what they want, and then go to the most expensive supermarket to buy the ingredients and spend hours cooking.” “OK, so it sounds like you’re setting yourself quite a high standard for that. What if you were to drop that standard a bit? What would that look like?” They might say, “Maybe I’d limit it to an hour to do the cooking,” or whatever it might be. But you’re right, Rob, you’d have to ask them, “And how will you know whether it’s been a success or not?” So you’d actually design what the criteria were as part of the experiment. Rob Wiblin: I suppose in the case of having an error in the email, that would be good if the person’s expectation was that they would get an abusive email back, but maybe not if their concern was merely that someone would secretly think less of them. In this case, you might have to come up with some other kind of approach. Can you imagine what that might be? I suppose this is a case where it might be very difficult, if you expect everyone to lie to you all the time about what they think. Tim LeBon: Well, I think then you’d get into the question of whether they were having a prediction that it was then impossible to disprove, and what evidence they actually had for it. Rob Wiblin: Yeah. And I guess if you can never see any consequence, then what does it matter, on some level? Tim LeBon: Exactly. Rob Wiblin: One thing I could imagine is, when I’ve been at my most depressed, it can feel like the thoughts are coming very automatically. It can be quite hard, I guess, to do this STOPP approach, and just notice that you’re feeling negative and understand why. It feels like you’re very stuck in the flow of negative thoughts and you’re definitely not choosing to have them. Is that a potential blocker, where it can just be very hard for people to step outside the feelings that they’re experiencing? Tim LeBon: Absolutely. With severe depression, we might be looking at medication. In fact, quite a lot of people, even people that are quite well informed, are under the impression that medication and an approach like CBT are mutually exclusive alternatives. And they’re not at all. Sometimes an antidepressant will take the edge off their depression enough so you can do the useful therapy. If that’s the case, then that’s what you might do. But as I said earlier, also you might need to break down that STOPP into very small chunks. You might teach them the ability to notice the thought, maybe write down the thought. Sometimes you get very mixed reactions to that. I’d say about 50/50. Half of people say, “I wrote down that thought. And you know what? It was so good because I just felt detached from it and it wasn’t in [my head] anymore — it was out there, it was on paper.” And then you get half of people who say, “Oh no, I don’t want to do that. It’s horrible, it makes it real if I write it down.” Rob Wiblin: “I wrote down that I was complete garbage and it’s just so true.” Tim LeBon: So true. So you might chunk it up into microskills of noticing the thoughts. You might just teach them the idea that thoughts are not facts. That’s quite a revolution for some people: “What is a thought? It’s just some chemicals going on in your brain, almost like a film in your head. Imagine someone’s playing a film and you’re watching it. That’s just like your thoughts going on. Doesn’t have to be true. Could be a load of rubbish.” So you just get a little bit of detachment from the thinking process. Rob Wiblin: I guess that opens the door to questioning, well, what evidence is there for these things? Tim LeBon: Absolutely. Rob Wiblin: Is it the case that some people, just in general in their life, tend to take the thoughts that they have at face value, or think that they’re likely true? Or is that maybe something that people slip into when they’re most depressed or most anxious, or the feelings are coming at them particularly aggressively? Tim LeBon: I think that’s a really good question, because there’s certainly quite a lot of evidence, not just that how you think affects how you feel, but how you feel affects how you think. So when you’re anxious, you will tend to think more anxious thoughts, and those anxious thoughts will be a lot more credible. When you’re depressed, you will think more depressive thoughts, and those depressive thoughts will be much more credible. That’s why it’s an important part of treatment, say, for anxiety — and this is jumping back to your question about various treatments, which I only gave a very partial answer to — to do exposure work. Sometimes it’s in the session — in vivo exposure work — where you’re actually experiencing the thing you’re anxious about. Something that I treat quite a lot in the NHS is obsessive-compulsive disorder. I haven’t treated it amongst many effective altruists — I don’t know why that is, interestingly. Obsessive-compulsive disorder can take various forms. It might be someone who cleans a lot, and they might also have an intrusive thought, which is the house will burn down, and then the response would be to do a lot of checking. They would check all of the electric sockets to check they’re all turned off. And then another doubt would creep in, and they’d have a kind of “better safe than sorry” attitude and then say, “Let’s check them another time.” They go back in and worry again and check it. We’ve all done that to some extent. Not that exactly, but we probably particularly if we’re stressed. This is an example of what you’re saying. If we’re on holiday, we think, “Oh, have I shut that window?” Sometimes we might even get halfway to the station and go back to check we locked the door. So when we’re anxious, we tend to think that more. But people with OCD, they get into a real horrible pattern of having those intrusive thoughts and then doing the compulsive behaviours. The problem is that those compulsive behaviours are then rewarded, because it reduces the anxiety — and so you can almost get addicted to them. Now, the reason I was mentioning OCD is that you draw out the map. You would say, “OK, what’s your intrusive thought that causes your anxiety? And then you do the compulsive behaviour, which then relieves it?” You might even get people to see that the intrusive thought is just a thought, and it’s probably not true. You might get them to see, in theory, that they don’t need to do the compulsive behaviour. That’s what you would do as the first step of therapy. But you won’t really crack the OCD until they are able to resist the temptation to do the compulsion when they’re really triggered. Now I just work remotely; I just work via Zoom. But before the pandemic, I remember being in actually a doctor’s surgery I worked in, in one particular setting, and this person was worried about dirt, so went outside and she got her hands full of mud. And normally she would spend hours washing repetitively, sometimes with bleach, until they were all kind of sore. This time she just washed once and then sat with the discomfort. So that is something called exposure. Actually, it’s called exposure and response prevention (ERP): It’s exposure, and then you prevent the response. The normal response would be the compulsion. You do the exposure, then you don’t have the reaction. Gradually, you break the cycle. You want to do it, but you tolerate the distress. The more you do it, the easier it is to tolerate the distress. I think that answers your question about the feeling causing the thinking and the tool that you need to do — which is to generate the discomfort, either in the session or outside the session, to check that they can cope with it in practice and not in theory. There’s all kinds of fun stuff going on there. If we think about the neocortex and parts of the brain like the amygdala, it’s probably the neocortex doing the STOPP, the cognitive restructuring; then it’s probably the exposure work that’s working more on the amygdala, reducing those very automatic fear responses. Rob Wiblin: One thing I’ve heard is that exposure therapy for phobias and these kinds of recurrent habits or obsessive behaviours is very successful. Or at least with phobias, as I understand it. Tim LeBon: If people do it, yes. Rob Wiblin: If people do it. I see. If people do follow through consistently on the treatment, then the cure rates are extremely high. I guess that’s something that people should know. If you have something that can be treated with exposure therapy, you should go for it, because this is one of the things that actually works. Tim LeBon: Feel the fear and do the therapy. Rob Wiblin: And we’re talking about obsessive-compulsive disorder here. There’s this other condition that I’ve heard of called scrupulosity, which is, I think, superficially a bit similar to moral perfectionism — in that people with scrupulosity have particular concerns about things that they could do that are wrong, like misleading someone or not being polite to people or charging someone the wrong amount by accident. They go through these cycles of constantly checking and constantly being worried that they might commit this kind of infraction. But it seems different from moral perfectionism to me. I guess one of the reasons is that the things that they’re concerned about are often very minor moral infractions, even if you would regard them as moral issues at all. They seem like somewhat more quirky concerns than someone wanting to perform at a high standard at work. Maybe that’s just my view on it. Tim LeBon: I’m not an expert in that, but I think I would understand it as being a subtype of OCD. There’s something which I work with a lot called generalized anxiety disorder, or GAD, which is someone who is concerned about normal worries, but they over-worry. We all might have concerns about health or finance or relationships; that’s normal. The person with generalized anxiety disorder would be worrying excessively and about too many things. That is kind of a normal type of worry, but just done excessively. Someone with OCD is often worried about sometimes bizarre, or sometimes just unusual things. Like the house burning down: we’re not all worried about the house burning down all the time. I’m thinking that what you’re talking about there with scrupulosity sounds a bit the same. Perfectionism would be about the things that we’re all concerned about: Are we achieving well? Are we being a good person? Effective altruists will certainly be worried about that. Someone with this dysfunctional perfectionism will be having that excessive or inflexible standard, and overrate the extent to which people will be critical (unless they’re in an environment where they really are critical), et cetera. Whereas I think this scrupulosity sounds more like someone who has an obsessive worry about something. They have a particular worry of “I’m going to offend someone” or “I’m going to say the wrong thing,” and then they might well do quite a bit of worrying. But then they might also have some compulsion. I mean, what would the compulsion be in that case? I think apologising or checking? Rob Wiblin: Yeah, the case of scrupulosity that really stood out in my mind was a patient who thought that it was very morally important, or incredibly important socially, to greet everyone at the office politely. That might be fine if you’re in an office of three people, but this person ended up in a leadership role in an organisation of hundreds — there were hundreds of people in the office, and it was massively interfering with their ability to do their job, because they would want to go around the office in the morning greeting everyone and having some polite interaction with them. To me, that is quite quirky, to the point where I think that’s not a concern that most people have, that they should greet everyone in the building. Tim LeBon: I would treat that like OCD, which is to say you have a thought or an intrusive thought that feels very alive to you, but actually it’s not realistic, it’s not helpful. What you’ve got to learn to do is ignore it. Rob Wiblin: Until it quiets down. Tim LeBon: Eventually it will quieten down. So we’d probably have some fun. I don’t know how you’d do that. I guess if you were doing a Zoom session with them, you could actually have people going into the office and not greeting them. That could be the homework, I expect. Rob Wiblin: Another thing I was going to follow up on is I always feel very cautious about kind of having some smug attitude towards people having a mental health issue, as if they’re thinking so differently than everyone else. Particularly in the case where people get stuck in their thoughts and just take them at face value as if they’re true: I think that is how most of us go about our day almost all the time; that is kind of how we’re designed to work. It’s just we have thoughts and then we don’t always want to step into this metacognition of thinking, “Well, I have this particular view of how this room is, but that could be wrong. It’s just my subjective perspective.” I’m not sure exactly why we’re not designed to do that. Maybe it’s just too much mental work. In fact, on a moment-to-moment basis, most of the time it’s fine to just be in your thoughts, in the flow of it, without deeply questioning it. I think we could surely all relate to maybe not doing enough questioning of our attitudes towards things or our perception of things. Often that’s fine, but then at other times it can be very problematic. Tim LeBon: To bring a somewhat theoretical dimension to that, I love Thinking, Fast and Slow by Kahneman and Tversky, and actually Robert Wright’s Why Buddhism is True would also have a kind of similar idea. The idea is there in the culture quite a lot: something like our brains are designed for prehistoric times. If you think of all the generations that happened in prehistory, where there were tribes of small groups of people and there were sabre-toothed tigers out there: we are primed to be very anxious, because the people who weren’t so anxious wouldn’t survive long enough to have children. Our genes are going to be primed to have more anxiety than is helpful these days when there aren’t sabre-toothed tigers. Also stuff to do with being very, very careful how you get on with those close to you — because if you were shunned by that community, you would starve to death. You mentioned there are several therapy modalities that I’m informed by, and CBT would be the top one. There’s also something called compassion-focused therapy, which I’ve trained in and which I love using. A phrase they have there is, “We have tricky brains.” We have tricky brains, and it’s not our fault that we have tricky brains, but it is our responsibility to do something about it. So there we are: we’ve got these brains that are designed for the Stone Ages. That’s what we’ve got. Another aspect — apart from what I was saying about anxiety and shame and being very concerned about how we’re evaluated by other people — is that this kind of “thinking, fast and slow” makes a lot of sense to be able to do stuff on autopilot to save mental energy. Because if you’re living in the world of sabre-toothed tigers, you don’t really want that “Oh, what is that sound? I think that might be something dangerous. Oh dear, I’ve just been eaten.” You know, It needs to be instinctive. It’s very easy to see how thinking fast would be our default mode. And the thinking slow — all that lovely stuff the human brain can do that other brains can’t do — takes a lot of energy, and it’s slower. So it’s not necessarily something that we want to do that often. If you’re driving or something, you’re just on autopilot the whole time. So it’s perfectly normal — and in fact, even beneficial a lot of the time — to be in, as Joshua Greene calls it in Moral Tribes, “automatic” mode and “manual” mode. I think he’s got the analogy of a camera, but I sometimes think of it as a car. Anyway, whatever, it’s good that we’ve got that automatic mode. Rob Wiblin: But sometimes it’s the wrong tool for the job. Tim LeBon: Sometimes it’s the wrong tool for the job because it’s very crude and fast. But sadly, because it was designed for prehistoric times, actually it very often will be the wrong tool for the job. It will give us the wrong intuitions or the wrong impulses or the wrong urges. I mean, there’s lots of literature these days about food and how it’s a racket, really, that we’re being addicted. You know, this advertising of sugars, and then we get addicted to it. Rob Wiblin: Our intuitions are that we need to get very high-calorie foods into us because we’re at risk of starvation, and the situation has changed so massively now, that’s a very harmful automatic response to have to food, in part perversely because we’ve changed the environment around us in a way that makes that destructive. Tim LeBon: Exactly. And also, part of our environment now is the whole food industry and advertising industry, which is then causing us to probably get addicted to sugar, which in any case, our whole physiology has evolved to crave it because in prehistoric times that was what we needed because food wasn’t so plentiful. So we have tricky brains. Another helpful idea, I think, is that mental health is a continuum. A lot of these ideas that I’m talking about for people that may have clinical levels of depression, anxiety, and perfectionism would apply to the general population, but just to a lesser degree. Which fortunately means that you can use the same techniques very often, even if you’ve got a very mild subclinical issue. Rob Wiblin: It occurs to me that there’s maybe two ways that one might approach this perfectionist mindset, or two ways that one might try to challenge it. One — which sounds like it’s the thing that you’re most often approaching people with — is to say, “This is very self-undermining. The thing that you’re thinking about is that you have to reach these incredibly high standards of performance at all times. Thinking that way has led you to now not be able to go to work because you’re feeling so negative and struggle to get things done.” Another angle that someone might take would be to say, “Even if this was working, or even if this was kind of functional, this is a cruel way to treat yourself. Or this is the wrong mentality to have about life because it’s just too harsh, it’s too brutal, it’s too inflexible.” To challenge it on those grounds. It sounds like mostly the thing that happens in these sessions is people coming to appreciate the ways in which the way that they’re thinking is not even causing them to achieve their superficial goals. Do things ever go to a deeper level, of getting people to reflect on whether this really is the philosophy or the values that they want to express towards themselves? Tim LeBon: A couple of answers to that. One is that part of the protocol for perfectionism would include looking at values. Certainly a very nice thing you can do is to draw a little circle, and then have little sections which would have all the things that might make up a good life — which might be things like work, being a good person, having a good intimate relationship, having good friends, having good hobbies, relaxation. You might say, “What percentage would you say that you devote to those things? And what percentage do you think they’re important?” Very often there’ll be a discrepancy. People might say, of course family or partner is most important, but in terms of where they put their effort, it might be 80% in work. You’ll notice — bearing on what I said earlier about Socratic questioning or guided discovery — that the client is finding that out for themselves, rather than telling them. That is definitely the preferred approach to helping them make their own discovery: “Gosh, yeah. What’s going on? I said that my partner is the most important person to me, and yet I’m devoting 70% of my efforts and I’ve just cancelled that dinner I was meant to go with them because I’ve got that important presentation tomorrow. No wonder they were upset with me.” So you can get them to see that there is a problem with their balance, and that’s generally the way we’d go with perfectionism. Perhaps we’ll go into the moral perfectionism thing a bit later. But with the general clinical perfectionism, part of the CBT protocol — but it comes quite late on; it’s not the first thing you would do — would be to say, “Let’s have a look at the pie chart of your values, how you’re actually living your life. Do you want to recalibrate a bit? And what would that look like?” And then there might be another experiment, whereby next week you work a bit less hours, or you ban yourself from working, or you ban yourself from looking at your work phone during the weekend, or whatever. They actually go quite hand in hand, because you have to have a different take on it. You have to realise that it’s actually quite problematic, this perfectionist psyche you’ve got into, before you’d be willing to try out that experiment. If you go straight on to the values stuff then you might, I think, have quite a lot of resistance. Rob Wiblin: There’s a tension in counselling or therapy of this kind, it seems, where you don’t want to tell your patients or your clients what to think. Because that would be, well, one thing is it might not work — because obviously just lecturing people doesn’t tend to go down super well. At the same time, of course, you do have ideas or conclusions that you’re kind of expecting or hoping that they might reach. It seems like in order to avoid this just being a sort of con — where you’re leading people to particular predetermined conclusions, and you wouldn’t accept things otherwise — you have to actually embody the attitude of what the person might say. Like: “No, I think that work is 90% important and family and friends and being nice don’t matter.” If that was what came out of their analysis of their own values, you’d be like, “OK, we’re just going to work with that, and I’m going to accept that because it’s not my place to tell you what to think or what to value.” Do you understand the tension I’m gesturing at? Tim LeBon: Yeah. What do you think is the number one quality that is needed by CBT therapists? Which could be one of those examples of a leading question, but I genuinely don’t know what you’re going to say. Rob Wiblin: Well, it sounds like the thing that would be very useful in this case is not having too strong of views about what values everyone else ought to have, or how everyone else ought to live. Tim LeBon: Yeah. And in general, curiosity. Rob Wiblin: Curiosity. Tim LeBon: Curiosity is a really helpful feature. You’re absolutely right: there is a tension. And again, particularly when we’re short of time as therapists and we see someone in real distress, we really want to help them, and we think we know what the answer is. Maybe we’ve seen someone like them before, and our pattern matching, our thinking fast, says, “Oh, they’re just like Client X. Client X was really helped by telling them to socialise more, so let’s tell them to socialise more.” But it may be that this person is depressed because the people they’re socialising with are really toxic and causing the problem. Rob Wiblin: Right. Tim LeBon: So it really is important to slow down and be curious. That’s what the formulation is about, that map. We’ve got our general map, but what is going on for this person? When it comes around to values, yeah, as well as it being counterproductive, there’s also an ethical concern that, as therapists, we’re trained not to just impose our values. It would be somewhat problematic for me to just challenge someone’s ethical views because I disagreed with them or I thought they were wrong. Rob Wiblin: Or at least not unless they invited you, or that’s what they came to therapy for. Tim LeBon: Sure. But even then, it would be quite problematic if they said, “Tim, what do you think?” Because then you’re being set up as some kind of guru, and actually, my views might be wrong. One has to be a little bit cautious in that. I think the best approach is that kind of guided discovery. There’s something else called “values clarification,” which is something that actually comes from education. There might be people listening who did this at school, where they’d be asked various thought experiments, like, “What would be your ideal day?” If you’re a bit older, the question might be, “What would you like written on your gravestone?” Or “What would you like people to say about you at your retirement party?” All those kinds of questions. Or I sometimes ask people, “What was one of the best days in your life? And why was it?” So I might answer — and I have to be careful because, my daughter might be listening — but one of my… OK, I can do both, actually: two great days. I was going to say, first of all, it was when my son was born, who was my first child, and I remember being really happy. Another one was when my daughter was born, and she was in my wife’s arms and crying like mad. And then she was passed to me and stopped crying. So I could take both of those as wonderful moments. Then what we would do in values clarification is, you would say to me, “So, Tim, why was that day when your son was born such a great day?” And I would say, “Well, it was…” Rob Wiblin: “I got so much work done.” Tim LeBon: Yeah. “It was love. There was this being and it was like really feeling love.” Well, that would be one of the answers. It might be a sense of achievement: I’m there, I’ve done something that I think was important. It may be relief, because he seemed to be healthy and my wife was safe as well. It’d be all of those kinds of things. With my daughter, it would be a real connection with her at that moment and a sense that I could be of help to her. So we’d say that those are very specific things that I valued at that instant, but then you can ask, “What does that generalise? Are those things that are generally of value to you?” In my case, would it be love, and achievement, and the wellbeing of those that I love, and close connection? I’d say, “Yes, of course it is. Gosh, isn’t that interesting?” Because by pinpointing a time, or even a moment, that I’d say is a high point, we’ve uncovered some values. That would be values clarification, and there are a whole host of other values clarifications you can do. But it’s not just clarifying the values. It’s then saying, “OK, Tim, so let’s look at your life now. How much are you living those values? What’s the discrepancy between what you think is important and actually what you’re doing with your life? What changes might there need to be?” I might say truthfully now, if we’re talking about my daughter, who is now 21 (I had to think twice) and abroad at the moment — she’s just gone abroad on a trip, a year abroad. So she’s not in my arms. I don’t know what’s happening to her now. So it might be a sign to give her a Zoom call or WhatsApp call over the weekend, and really take a close interest in her, for example. Rob Wiblin: OK, let’s switch on to a slightly different angle on this. I can imagine some listeners being a little bit frustrated with the conversation so far, because we’re placing all of the responsibility for fixing this issue on the people who have this mentality and maybe are struggling with it, or people who are dealing with perfectionism as a challenge in life. You could turn this around and say, “Well, Rob, at 80,000 Hours, the way that you talk about all of these things and the messages that you promote might well be contributing or causing or stimulating people to form this kind of attitude towards themselves and the world and their responsibilities. Shouldn’t you also think about what you could do differently to avoid prompting this?” We’re happy we’re doing this episode, in part because we definitely have noticed that among people who listen to this show or people who are interested in our careers advice, having very high inflexible standards and shame when someone fails to meet their own high standards is, I think, more common among that group than the population at large. Although of course, it’s certainly not confined just to people who are into effective altruism or 80,000 Hours. To what extent we’re causing it, I’m a little bit unsure. Because there’s another phenomenon, which is that people who already think that way are extremely drawn towards the way that we write about careers and about ethics. There’s going to be a selection effect as well as potentially causing it, but inasmuch as we’re causing it, we definitely would want to tamp that down. Do you have any advice for me, or 80,000 Hours, or listeners at large, who, in the way that they speak or think, might be generating this among people they know? Tim LeBon: Well, I’m not going to presume to be an expert in what goes on at 80,000 Hours or in the effective altruism community in general. First thing, I need to make that really clear that I’m seeing a biased sample of people who are presenting with issues. So I’d be really interested actually in wellbeing questionnaires amongst the effective altruism community. I know there’s been one done in Spain, I think, but I’d be really interested in that being expanded. Because on the one hand, you’d expect effective altruists to have a higher mental wellbeing. People working for an effective altruist movement, say in 80,000 Hours, I’d expect them to have a higher wellbeing because they, in general, like the people they’re working with. When I left university, I worked for an organisation called Logica, which was a bit like being at university but getting paid for it, because you’re with bright people you like to socialise with. I imagine that 80,000 Hours can be a bit like that, where you’ve got a nice peer group, you’ve got a common interest, there’s meaning to your life, you might be being stretched. So there’s lots of indicators where you’d think these people are going to be flourishing. But to answer your question, after all those caveats I’ve made, what concerns me, potentially, is that idea of “doing the most good”: that as a moral imperative, kind of a very crude act utilitarianism. Because if that is kind of the dictate from on high — or thought to be the dictate from on high; I’m sure it isn’t — that you’ve got to do the most good in every moment, then you’re setting up for moral perfectionism. Because it’s unpredictable, first of all, in terms of what the consequences will be of what you do. Also, coming back to that old-brain/new-brain thing, I think the way that we’re designed as human beings, we’re going to favour ourselves to some extent. We’re going to favour those nearest and dearest to us. Even if logically we should be totally impartial, there’s going to be a bit of our brain that rebels against that, I suspect. So having it as an imperative to “do the most good you can” all the time: even if that isn’t actually what is meant, I think some people might take it to be that, and particularly maybe if they have this parental message that you’ve got to achieve the most, then that potentially makes them very vulnerable. And then if there are people in the organisation — coming back to that mythical survey we spoke about — who would answer, “Oh, you’re a terrible person because you did such and such or didn’t do such and such,” then that’s not going to be great either. Again, I certainly hear clients fearing that that might be the case, but I don’t know to what extent that really is the case. Rob Wiblin: Yeah, I don’t think it is true. I mean, I can only speak for 80,000 Hours, but I think if you did a survey like that, you’d find that everyone is extremely tolerant of the lifestyles that other people want to lead. I mean, even people who do nothing to improve the world, to be honest, are perfectly accepted as friends. I think there’s a perception that there would be enormous amounts of moral judgement. And I’m sure that’s true of some people, but at least I have friends out there who have virtually no interest in altruism or doing good. And to be honest, it doesn’t bother me. It almost doesn’t bother me to a remarkable degree. Tim LeBon: But they’re friends. What about if they were working for 80,000 Hours? Rob Wiblin: If you had a colleague? Well, I suppose I’ve learned from experience with these issues that in general, it’s extremely counterproductive to have a mentality that you always have to be giving the absolute maximum to work. I guess on pragmatic grounds, I think it’s foolish to have these kinds of standards, certainly among a group of people who are already quite inclined towards altruism and perfectionism to start with. It’s just throwing too much fuel on a fire that’s already burning perfectly healthily. On top of that, just speaking for myself, I feel I no longer have the energy for massive amounts of moral judgement about people’s work. I just have other things going on, and I guess I don’t find it that fulfilling or satisfying to think about ways that other people are failing morally anymore. I think maybe 15 years ago I had more fire in my belly about this, not that I was ever super judgemental. But I guess there’s just interpersonal variation on how agreeable you are, and how much you think about this. Tim LeBon: Exactly. So as I said, most of the people I’ve encountered as clients are very lovely people and haven’t got that OCD personality, where they’re insisting other people have the high standards. My worry would be that it’s just there in the ethos, as it were: that’s what we think is expected of us. That would be one thing. With regards to careers advice — and again, I actually don’t know what you say to people that come for careers advice — if it was hypothetically, “I’ve done this little calculation, and this is the job where you’d do the most good, and this is what you’ve got to do,” that would worry me. Because the way I like to think of it is there’s kind of Venn diagrams of a job that you can have a high impact in, a job that you’re good at, a job that you would actually enjoy and find personally satisfying, and a job that would pay the bills. So those four things. And I think you want the bullseye, rather than just doing a job because it’s the one with the most impact — and you hate it, or it doesn’t pay any of the bills you need. Again, I don’t know the type of advice that you give, but I would be concerned if it was too prescriptive and too much just discounting: “You’d probably enjoy it, but you’ve got a moral imperative to do good.” Rob Wiblin: Yeah. I think in practice, if people got one-on-one advising or they read the website carefully, they would find that this personal fit and the importance of enjoying what you do and having a holistically good life is emphasised quite a lot. I would be shocked and a bit dismayed if anyone had a one-on-one session where they were ever told, “Here’s the job that you should definitely take.” Maybe you would get, “This might be the job that is highest impact, but you have to consider all of these different other factors as well.” It’s extremely hard to have a message that is suitable and beneficial for everyone, given the enormously different starting points that people are coming from. Part of our message is about doing the most good, and you can have a really big impact with your career. That’s partly orientated at people who have never thought about this at all and maybe are not really aspiring necessarily to help people at all with their career. Of course, the same message falls on the same ears of people who are already very concerned about how much good they’re going to do, and already have extremely high expectations about what they might accomplish in their career. And for them, it’s like it’s too much: you’re overloading someone with particular thoughts that they’ve already got a good level of, or maybe they already have too much of it. Whereas there’s other people potentially who — in our view at least — should think about this more, because they’re currently not thinking about it almost at all. Yeah, that would be my model: that it’s just extremely hard to have a message that is beneficial to everyone and doesn’t backfire in some cases. Tim LeBon: I think that’s right. It’s almost like, I’m thinking of a temperature gauge, and there’ll be someone at this end who needs to go in that direction, and someone at that end that actually may need to go in this direction. And whatever general message you’re giving, if it’s taken too literally or people think it’s about them, or they misread it, or misunderstand it, then it could backfire. Rob Wiblin: Yeah. One thing I might add before you go on is just that I waste an ungodly amount of time, and I spend lots of time just doing stuff that I enjoy — that I don’t think makes the world a better place necessarily, except by making me happy. I spend lots of money on myself, and I don’t feel guilty about it at all. My colleagues seem completely fine with this. I’ve never gotten a hard time from anyone. So, I suppose, as a listener, if your perception was that if you did that, I would think negatively of you, or that working at 80,000 Hours would be terrible because everyone would just be breathing down your neck all the time about how you’re not the ideal moral person, I think at least that perception is not the case. Though I know that won’t necessarily make everyone feel completely better. Tim LeBon: Yeah. It’s good to get that message across, I think. Rob Wiblin: One other thing that I have come to think about over the years is that there’s many big benefits to having friends who share your moral convictions, or your passions about changing the world, or your political outlook, your environmental concerns, and so on. I think this is one of the ways that isn’t beneficial, and that it can actually be harmful. Because if many of your friends, your colleagues, all of the people you spend your time with, all share your particular view on what people ought to do, now you’re just getting this message all the time. It’s not just your views, but you start getting this social reinforcement that this is the way you ought to live. There’s this very general phenomenon in psychology called “extremisation,” which is if you get a bunch of people who all have a particular view and you get them to talk to one another, they almost always come away with a more extreme view than what they started with. You can just kind of see this playing out over time in basically all social groups, even just social circles who happen to, by chance, have come in with particular opinions. Although there’s huge benefits to being able to hang out with people who have common interests and talk about the same things all the time and work on projects together, if you’re someone who’s at risk, I guess you might say, of having extremely high inflexible standards and moral convictions, then you might want to consider whether you do want to put so many of your social eggs in one basket. Because I think this is one of the things that if the fire is already burning bright, then this adds more fuel onto it. Tim LeBon: Exactly. Rob Wiblin: Early on, when you’re dealing with a new client, are there any questions that you want to ask in order to distinguish whether what’s going on might not be perfectionism, or that there might be a different issue at play? Tim LeBon: Very often we’ll get referrals from a GP when I’m working in the NHS. And when I’m working in private practice, I would ask people about physical problems, medication, mental health history. Obviously, if one’s interested in perfectionism, there’s a bit of a trap there of seeing perfectionism everywhere. So it’s curiosity again, and open-mindedness, and thoroughness as well. Just to give a classic example of that: a disorder that we haven’t mentioned so far today is panic attacks. Someone who’s suffering from panic disorder, sometimes one version of it is they experience their heart beating irregularly or really fast. So they feel anxious, and they then have a catastrophic thought that they’re having a heart attack. What do you think happens to their anxiety? Rob Wiblin: Goes through the roof. Tim LeBon: Then, of course, the heart beating fast is a symptom of anxiety. So what happens to their heart? It races faster. What happens to the credibility of their belief they’re having a heart attack? It goes up. What happens to anxiety? This happens very quickly and it’s not like it’s “Oh, I’m having that thought.” So that’s what a panic attack is. The treatment for panic disorder includes mapping out the cycle and distinguishing the symptoms that they think are a heart attack from actually just symptoms of anxiety. Going into those situations, knowing that those are just symptoms of anxiety and they don’t need to be concerned about them. Now, that’s all very well and good, as long as you know that they’re not really having a heart attack, right? Because if they’re having a heart attack, what we want to do is to rush off to A&E. Rob Wiblin: Right. Not start a CBT workshop. Tim LeBon: Not say, “Oh, nothing’s going on here, I don’t need to be worried about it.” So in those cases, one has to actually get — Rob Wiblin: To a cardiologist, maybe? Tim LeBon: At least a GP, as to what’s going on. And then hopefully they’ll have had their tests, and if they come back and say there is nothing wrong with their heart, then you’ve got the evidence. And they’ve got the evidence as well. Rob Wiblin: A classic thing that you often want to detect is whether someone has thyroid issues, right? Or there are a whole lot of physical illnesses that can present as mental health issues, where I guess if someone has too much thyroid hormone, they become anxious, and if they have too little, they become depressed. Am I remembering that right? Tim LeBon: I mean, you’re absolutely right that there can be physiological things that present as if they might be anxiety or depression issues, and then you’re targeting the wrong thing. So, yeah, it’s a good idea to get the physical side checked out as well. Also, increasingly there seem to be a number of people who come who are neurodiverse and perhaps with ADHD or autism. ADHD is something that can manifest itself as anxiety or low self-esteem, or in all kinds of ways. It doesn’t mean you can’t do the psychological treatment, but you have to take into account that they might also need to see a specialist to help them work with their ADHD. Rob Wiblin: OK, let’s push on from perfectionism now. You told me earlier this week that the other big cluster of challenges you find people who are trying to do a lot of good with their career dealing with is low self-esteem and imposter syndrome. What does that look like in practice? Tim LeBon: There’s been quite a lot of research on low self-esteem, and quite a well-tried and tested CBT protocol for helping with it. Melanie Fennel is the person most associated with that. It tends to go like this: It’s someone who often — because of some adversities in childhood — gets the message that they are not good enough. That might have various flavours, such as: I am unacceptable, I am stupid, I am unlovable, I am ugly, I am unintelligent, or whatever. But basically: I am not good enough. They might have that message because maybe they were a bit different, or maybe they had parents or teachers that were just very mean to them, or they might have been bullied. They grow up really believing, in a really felt sense often, in not being good enough. And then what happens to them? Well, they try and get by, even though they think they’re not good enough. So they tend to adopt certain rules for living. Which might be people-pleasing — because “I’m not good enough, but maybe if I’m really nice to people, they will accept me.” It might be avoiding particular challenges — because “I don’t want to set myself up for failure. What’s the point? I’ve been told I’m useless, so what’s the point in going for that job?” It might be worrying — because “If I worry, then I might be able to stop this bad thing happening to me. I shouldn’t just do something without thinking about it, because I’m not good enough. I need to think really carefully before I do stuff that other people do.” Now, those things might well be problematic, although they do them for good reason — because they’re compensatory strategies, if you like, because they think they’re not good enough. So if they worry, then they’re going to have a lot of anxiety. If they people-please, then they’re not going to get in very satisfying relationships and their needs might not be fulfilled, or people won’t just find out that they need help. If they say “Oh, that’s fine with me” and it isn’t, then they might set themselves up for failure. If you’ve got someone who works for you and they’re a people-pleaser, then they’re going to say yes to everything when they might mean no. That’s a bit of a problem potentially, Rob Wiblin: Overcommit to stuff. Tim LeBon: Overcommit to stuff, exactly. They also might just avoid lots of opportunities for success, just say no to good things. Someone with low self-esteem — for good reason, in their own belief system — does all these protective strategies, which will cause anxiety and also might self-sabotage. So there’s kind of two paths that they go down. There might be a trigger situation — like they have to do a presentation or something and then because they think they’re not good enough, they will get all kinds of anxious. They might be in a world of anxiety a lot of the time. And then if they self-sabotage — say, by worrying before the presentation, or for some people it might be drinking or taking drugs or whatever because they just want to avoid this horrible feeling of being anxious — then guess what happened? They might actually not do the task very well. They might, in a worst-case scenario, not even turn up for the presentation because they haven’t prepared for it. And then what will happen is they will go to the other path, which is depression. When you fear that you’re going to be exposed to be not good enough, you feel anxiety. And then when you feel that has been the case, some people might well be very harsh self-critics and say, “You idiot. Why did I even agree to doing that presentation? I knew it would end in tears. I’ve got to learn not to do that. I’m so stupid.” They would then ruminate, which is another big issue that in CBT we can help people with. Worrying is overthinking about the future; rumination is overthinking about the past. Going over in your head, “Why did I do that?” for all the bad things that have happened to you. How are you going to feel if you do that? Terrible. We talked earlier about shame. Shame might come into it, which would mean you might feel, “I’m just unacceptable as a person.” The original core belief you had — “I’m not good enough” — is actually reinforced. Because either you’re self-sabotaging — which I don’t really like that expression, but people use it a lot. It’s actually you’re doing stuff that makes it appear to be true, or it actually is true, or else you’re avoiding challenges, which means it’s never falsified. So if you’re people-pleasing, then you might say, “Yes, they did agree to me going out on that social occasion, but it’s only because I’m so nice to them,” when actually they might have done so even if you were just your normal self. Does that make sense? Rob Wiblin: Yes. Tim LeBon: It means you never find out that you are good enough. That’s why this self-esteem is another vicious cycle; it’s a bit of a puzzle otherwise. So a parent, when you were a kid, told you that you weren’t good enough. But you’re 40 now — why do you still think that? It’s because you’re looking at the world as if this belief is 100% true, and you’re interpreting everything as if it is true, and you’re doing stuff that actually sometimes makes it true. Rob Wiblin: So any contrary evidence in any specific instance, you disqualify, and say, “Well, here’s the alternative reason why.” Tim LeBon: Yeah. “They only accepted me because I was nice to them.” That kind of thing. Rob Wiblin: It’s interesting. In both of these cases — perfectionism and low self-esteem — it seems like the key issue is that you set up a positive feedback loop within your emotional system. Where someone with low self-esteem, so long as they’re doing great at work and people are accepting them, then maybe they can get by. When something goes wrong — when actually for the first time in a while, they do a really bad job at something — then they’re going to feel terrible because people might actually be annoyed with them. And that’s going to make them unable to do the next thing. They just fall into a hole. Tim LeBon: Exactly. People with low self-esteem, they might very often have periods where they seem to be OK, although they generally won’t be flourishing as much as they would be otherwise. But they will also be prone to periods of anxiety and depression, as can people with clinical perfectionism, because it’s a bit of a puzzle as to why people are both anxious and depressed at various times. But both of these possibilities explain it. Rob Wiblin: Yeah. It suggests that one of the core ways that you might try to have more robust mental health is to set up the exact reverse system, where you need to have negative feedback loops: where if you feel bad, then you need to lower your standards, for example, and be far more nice to yourself — be particularly compassionate and particularly accommodating of yourself in those times, in order to lift yourself back up. And maybe to some degree, the reverse: when you start feeling maybe a bit too good about yourself and a bit too confident, then you need to remember that maybe things will go worse in future and tempering down your expectations. Tim LeBon: Exactly. Very often, once you’ve mapped out someone’s particular cycle, the solution is to do the opposite. For instance, if you’re ruminating about all the bad things that have happened, you’d stop doing that and maybe think of all the good things that have happened. Part of the treatment for low self-esteem is a positive data log, which is thinking of all the good things you’ve done — particularly things that contradict your negative belief about yourself. Again, all those thinking traps we mentioned earlier — like discounting the positive, mindreading, fortune telling, jumping to conclusions — people with low self-esteem do a lot of those things. You’d teach them how to challenge those things so they’d have a more balanced view. Another key idea that comes into CBT a lot — at least it does when I do CBT — is something called Theory A and Theory B. Theory A with self-esteem would be: “The problem is I’m not good enough.” Theory B would be: “The problem is I worry I’m not good enough.” Theory A is the problem is what I’ve been thinking it is all this time. Theory B is it’s a problem of worry about it. You put those two possibilities and you ask people about the evidence for each. And if they’re a little bit into their CBT, they would say, “Gosh, yeah, this is just a problem of worry.” Then you’d say, “Well, if it’s a problem of worry, what have you got to do?” Then it’d be exactly what you said: probably changing all those behaviours, sometimes to the opposite. Another thing you can do is to undermine the credibility of the person that gave them that message. If it’s your parent that gave you the idea that you weren’t good enough, you’d ask, “So are they an authority on who’s a good person? What were they like?” And they would probably say, “No. It seemed so at the time, when I was eight years old. Now looking at them, they made a mess of certain aspects of their life. Why should I be treating them as the authority?” Of course, that’s just the neocortex speaking. So what you have to do then very often is the behavioural part, which would be those behavioural experiments again, which is to live as if I am good enough. What would you do if the narrative that you’ve been believing all this time was false, and actually you are good enough? You’d be dropping all those safety-seeking compensatory strategies and doing the opposite. Maybe you stop people-pleasing, say what you think a bit more. That feels a bit dangerous. So then you’d have to design one of those behavioural experiments which was a not-too-risky one. Rob Wiblin: Yeah. One that doesn’t feel too risky, but one where they would predict that they’ll get a negative reaction. Hopefully if it’s the case that low self-esteem is the issue, then probably they won’t get a negative reaction. Tim LeBon: And it can get complicated, because if I was playing devil’s advocate, I would say, “But what if it backfires?” Of course it can backfire, because it may be that those people who are people-pleasers attract as friends people who like people-pleasers. If this person says, “Let’s go to my favourite Greek restaurant,” and that person starts saying, “No, I actually fancy an Italian today,” then they might get some, “Why are you in a bad mood?” because they’re not used to that. So you have to kind of prepare them. Part of this might be assertiveness training as well, and being prepared to kind of fight for their cause a bit. So it’s sometimes not quite as easy as just doing the opposite and hey presto, everything is wonderful. Rob Wiblin: Yeah. I suppose you might end up concluding that low self-esteem might be a part of this, but so is that the relationships that you have in your life are maybe on the wrong keel — that you need to recalibrate the dynamics that you have with your friends and family and colleagues and so on. Tim LeBon: Might even change some of them. Rob Wiblin: Could happen. We’re suggesting these various changes, like, “When you feel bad, what you should do is be particularly kind to yourself. When you feel like you failed, that’s when you should show the greatest compassion.” It’s so easy to say that, but if someone’s in the habit — as I guess to some extent almost all of us are all the time — that when we fail, our reaction is to feel bad and to feel some degree of guilt or shame or negativity, how do you intervene in that? Tim LeBon: So, in Stoicism, there’s something called the “premeditation of adversity.” You can do a version of that in CBT. You have to be careful with this because if someone’s at their lowest, you don’t want them to be thinking about the worst thing that can happen. But if they’re well into therapy, they’re not quite so depressed and anxious as they were, and they’re working on their low self-esteem, then you would want to not do a general premeditation of adversity, but you’d certainly want to say, “OK, going out with your friend, your friend always insists on going to a Greek, even though they probably got the message now that you prefer Italian. What if you were to say, ‘Let’s go to Italian today?’ and they get all stroppy about it? How are you going to deal with that?” So it’s not just premeditating adversity, it’s also thinking of a coping strategy. In other words, you talk about it and then you might also do an eyes closed rehearsal. Remember we were talking earlier about how you feel affects how you think? You try and get them to vividly imagine it, because it may be when they’re talking in a very calm, clear, and collected way, they’re able to say, “Oh, yeah, I’ll just be assertive.” “I want you to really imagine and there’s this friend, and say in their tone of voice, ‘Why are you being awkward? We always go Greek. You like Greek, don’t you?’ How do you feel when they say that? Given that you’re feeling that thing in the pit of your stomach, what could help you to say that assertive thing?” It might be something like a breathing exercise. Perfectionism and low self-esteem, although they presented them as very different, they can go alongside each other. Because if someone’s perfectionist, they’re going to be subject to low self-esteem — because, remember, their standards are unfeasibly high and inflexible, so they’re going to feel they’re not good enough. So perfectionism can cause low self-esteem. Also, if someone’s got low self-esteem, they can adopt a kind of perfectionist attitude as a kind of safety measure of, “I’m not good enough, but if I spend hours and hours on this task, it’ll look like I’m good enough.” Rob Wiblin: Right, I see. So it’s a compensating strategy. Tim LeBon: Yeah. And sometimes it comes up, if I’m supervising other therapists, as to what’s the difference, or if I’m trying to work it out myself. I think the key answer is whether the standards themselves are the problem. If it’s a problem with the standards, then it’s probably more perfectionism with low self-esteem being a symptom. Whereas if it’s the messages that they’ve got that they’re not good enough, then it’s probably more low self-esteem. But even then it can be a bit of each. Rob Wiblin: Yeah, totally. The other thing I was going to ask before you move on was: there’s low self-esteem and there’s imposter syndrome. Do they go together extremely often, or is there a distinction here? Tim LeBon: Well, imposter syndrome, when we’re talking about diagnosis, neither low self-esteem nor perfectionism are in the DSM. The DSM is like the psychiatric manual. They’re not full-blown, diagnostically, disorders, but they’re things that therapists find clinically useful. Rob Wiblin: I guess they’re like patterns of thought and patterns of behaviour that we can all recognise. Tim LeBon: They’re definitely a thing, aren’t they? Impostor syndrome is a newer one of those things. When I did my CBT training, actually at that time self-esteem was taught, but not perfectionism — because perfectionism seems a bit of a newer kid on the block. Impostor syndrome seems like a newer kid still on the block. It does seem to be a thing, and perhaps particularly a thing that I’ve encountered more when working with people from effective altruism. Impostor syndrome is, to simplify it slightly, where people think they’re not good enough, but they somehow get accepted into a job that they think is really good or a university they think is really good. And so they feel like an imposter. They also think that if people discovered how they really were, they would get rejected or kicked out. Rob Wiblin: Sounds awful. Tim LeBon: Yeah. So they might well be that kind of person who then becomes rather perfectionist as a compensatory strategy. They might also have rather high standards in terms of what they believe other people are. So it’s a combination of low self-esteem and perfectionism, very often. What really helps those people is to realise that we are all fallible, imperfect human beings — even those people who seem really successful and never make a mistake. In that case, a kind of survey can be really helpful of someone that you really admire. Actually ask them, “Do you ever feel a bit impostery? Are you always as confident as you appear to be? Have you ever made a serious mistake?” The realisation that actually we’re all fallible, we all make mistakes, is one thing that’s helpful. And sometimes these people put their success down to luck or something, so sometimes it’s helpful for them to start to realise that they have got strengths, and that a lot of the good things that have happened have been down to their good qualities. I mentioned the positive data log. Also a very powerful tool — which people might like to do this even though they’re not in therapy, if they think they’ve got low self-esteem or imposter syndrome — is to just ask some friends, “Can you say some of my good qualities? Can you just tell me some of the things you like about me and give me some evidence for it?” Give an example, because otherwise we’ll tend to discount it and think they’re just being nice. If it’s, “Oh that time when I was really low, you were the one person that took time to listen to me for half an hour, and then you checked in the next day to see how I was. So I think you are a really kind person, and that’s evidence.” That will start to chip away at their belief that they’re not good enough or that they’re an imposter. So that’s another good technique. Rob Wiblin: Yeah. One of the big insights that has gradually gotten incorporated into me at a gut level over many years is just that no one is as good as it seems, or no one is as good as what gets presented. The thing is, we can see that so much with ourselves because we’re seeing through our eyes 24 hours a day. I suppose the example of this that people talk about a lot is of course people put up their happiest photos on Instagram, or they present this very curated vision of their life on Instagram. But that same phenomenon applies everywhere. You see extremely filtered examples of people’s work. If people produce something bad, then it doesn’t get pushed out and so you’re just unlikely to hear about it at all. People kind of bury their failures and don’t talk about them so much in conversation. Successes tend to get just repeated a lot, whereas mistakes that people make, they just never mention them to anyone else. That’s a very natural thing to do. If you just take people’s presentations at face value, you’re going to think that everyone else is better and more successful and makes fewer mistakes than you do. Also you’ve got regression to the mean. Some people, you might think they’re really amazing because they’ve had a streak of good luck so far in their career. But if you set a reminder to look back in five years, often you’ll find that things have gotten a bit worse after that because you’ve tended to notice them and idolise them at the moment when they’ve kind of achieved their peak level of success, or at least their highest ratio of success to mistakes. I think even people who notice this phenomenon tend to underestimate how pervasive and how intense it is, and I imagine this is a big issue for people with imposter syndrome. Tim LeBon: Exactly. It’s kind of part of the human condition, as you say, that we know our lived experiences very well. We know our doubts, we know our failures. We know our faults only too well. At least most of us realise that. If we haven’t, then we’ve probably got a different psychological problem. Yet other people, as you absolutely say, whether it’s public figures or even friends, very often we’ll just see a public part, not the private part. So yeah, it’s a problem with the human condition in a way, that we’re all going to potentially feel that we’re worse or not as good as other people, because that’s all we see. Rob Wiblin: OK, let’s push on and talk about another big personal passion of yours, maybe the other big passion of your life, which is Stoicism. As I mentioned, you’ve written a couple of books about Stoicism, and you’re also Director of Research for Modern Stoicism, part of the Aurelius Foundation, and you co-facilitate Stoic Week. So fair to say you’re a big fan. Tim LeBon: Just a slight adjustment. I co-wrote Cobwebs, in case Chuck Chakrapani is listening. Or even if he’s not listening, people should know. Rob Wiblin: He can’t write in a complaint email, yeah. First up, I guess loads of people will have heard the term Stoic, but you mean something a bit more specific than the standard meaning. When we say someone is “stoic,” usually we mean they have a stiff upper lip. Stoicism in philosophy and in mental health means something a bit more than that. What is it to you? Tim LeBon: There’s two parts that I need to answer that. You’re absolutely right, Rob, that in the English language, stoicism does mean stiff upper lip. Not complaining, carrying on, even though things are tough. That is kind of a caricature of what the ancient Greek and Roman philosophy was. As with most caricatures, there is an element of truth to it. But true Stoicism is much richer and much more helpful than that, because actually, there’s evidence that that kind of stiff upper lip has got some positives, but it’s actually probably more problematic than helpful in general. So it’s not something I particularly recommend. Rob Wiblin: If you had to boil down what modern-day Stoicism is to you, are there like three principles, or is there a slogan version of it? Tim LeBon: Marcus Aurelius, Meditations 9.6 is a summary capsule statement, and it goes like this: Rational judgement, now, at this very moment. Act for the social good, now, at this very moment. Willing acceptance, now, at this very moment, of what you can’t change. That’s all you need. I think that translates into what I’ve come to call the three pillars of Stoicism. That’s not official; this is what I call them. I see them as the three pillars of Stoicism. So the last one in Marcus Aurelius was the willing acceptance at this moment of what you can’t change. So that is a “dichotomy of control.” That is actually probably the number one thing that people really appreciate in Stoicism. If I’m working with someone, particularly in private practice, people do sometimes seek me out because they know I know a bit about Stoicism. They’re interested in Stoicism. The dichotomy of control is usually where we start. It goes like this: Suppose someone’s going through a difficult relationship issue. You’d ask them, “What aspects of the situation can you change, and what can’t you change? And the aspects that you can’t change: What is the best attitude? And the aspects that you can change: What is the best attitude?” And what do you think the answer to that is? Rob Wiblin: So the first decision tree is: Is this something that I can change, or is this just some background uncertainty about the world that I really can’t affect? Then the question is: What sort of disposition should I bring to these issues? Yes, I’m actually not sure. Tim LeBon: If you generally can’t change it, then it’s best to accept it — which doesn’t mean approving of it. If you’re stuck in traffic and you can’t change the fact that you are stuck in traffic, is it better to get angry and turn into a kind of Basil Fawlty? Or is it better to recognise that this is just something that’s happening, that you’re better off not using your energy railing against it? So if you really can’t change something, accept it. What about the stuff that you can change? Well, the good old Serenity Prayer, which also is probably inspired by Stoicism (or if it wasn’t, it’s a heck of a coincidence) — “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference” — would suggest you need courage and wisdom. And I would suggest that you probably need something like proactivity as well: be really proactive about the stuff that you can change. We get into problem solving and planning. There you are, you’re stuck in traffic. You can’t change the fact that you’re stuck in traffic now, but what you might be able to do — if you can do so safely — is contact the people who are expecting you and tell them that you’re going to be late. What you might do in the future is set off earlier or go by train. What you might do if you feel strongly about it, is have some campaign for a better transport system in the country. So that’s why it’s not about stiff upper lip or quietism, because there’s this very important branch about aspects of a situation that you can change — where you want to do your best to change it, if it’s worth changing. Does that make any sense? Rob Wiblin: Yeah, completely. The case of being angry when you’re stuck in traffic — I often get frustrated or anxious or even a bit ashamed when I’m running late for something, and I do have to stop myself. The interesting thing is the feelings, the negative feelings that you’re having, they have this intense feeling of being useful somehow. You feel like this is an appropriate reaction, and to simply remain calm would be negligent somehow, or failing to accomplish something. I suppose often it actually is directly accomplishing nothing; it’s actually just causing you harm. I suppose the Stoic approach would be to say, “Well, what actually could we do?” Maybe you should learn a lesson about next time you need to leave earlier, rather than just accept the motions. Think about what actions or what changes could be made, and then what dispositions would help to serve that. Tim LeBon: Absolutely. The Stoics, of course, didn’t know their neuroscience, or hadn’t read Kahneman and Tversky, et cetera, but we could say this is our old-brain creating these emotions, or creating these automatic thoughts, which actually aren’t helpful for us in modern-day life. They might have been helpful in prehistory, I don’t know, but they’re not helpful now. We have to have that detachment to get our neocortex working, and actually decide what is functional here. That’s the same kind of thing that one would do in a STOPP that we talked about with CBT. Obviously the two — CBT and Stoicism — are quite closely related. So it doesn’t come naturally very often, and it does require some awareness. Tim LeBon: So coming back to those three pillars I mentioned: the second one are the virtues. I was doing a talk at my workplace the other day, and I had a counsellor come up to me in the break and say, “Very interesting what you said about Stoicism. I didn’t like what you said about the virtues. I hate the word ‘virtues.'” I said, “Don’t worry about the word.” I didn’t say this, but I wish I had: the Greek word for it was arete, which just means “excellence.” So think of the virtues as just being skills that help you live an excellent life. Think of it as being like a virtuoso, like a violin player would be a virtuoso at the violin: the virtues are things that make you a virtuoso at living well. Living well means it’s a win-win between you having a flourishing life and you being a good person. But this idea, of not just Stoicism, can give the wrong impression and give a very negative feeling for some people — and also the expression “the virtues.” Rob Wiblin: Maybe in the modern world it’s associated with Aristotle and a Catholic theology and kind of religious thinking. But if you just replace “virtue” with “positive quality” or “what disposition should I have?”, it feels like it’s obviously a sensible way of thinking. So why is it that the Stoics foreground virtues or qualities or dispositions as the thing that you should be selecting? Tim LeBon: I think it’s helpful to think of the virtues as qualities that help us deal with our tricky brains. Now, that might not be in exactly the way that the ancient Stoics positioned it. Rob Wiblin: Is that a quote from Marcus Aurelius? Tim LeBon: Possibly not, but it’s the same thing, really, just in different language. The virtues are things that help you live a happy life and be a good person. I think it’s helpful — since we know about tricky brains — to position it that way, or to frame it that way: that it’s tricky being a human being. We have fears that mean that we might not do stuff that would actually benefit us and other people. We have desires that — if we let them run free — might get us into trouble, might cause bad health or might cause problems in our relationships. For instance, we live in communities. And we might actually be geared to be rather self-interested, because if we weren’t self-interested, we wouldn’t have survived. But If we are purely self-interested and disregard other people’s interests, that would be problematic for us and other people. We have these brains, but as we’ve said at length, these are rather tricky brains and we seem to be geared to not just be self-interested, but also to prioritise the now and the short term in favour of the long term. We don’t always use this capacity to have rational judgement now, at this very moment. What are the four qualities that we need to counteract this somewhat problematic part of the human condition? Very broadly, we could say that we need courage to deal with fear; we need self-control (or moderation or temperance) to deal with some desires; we need justice, in a very broad sense, to include things like benevolence and compassion and kindness and love to counteract our possible selfishness; and we need wisdom so that we make good use of these wonderful neocortexes that we have. That would be my rationale for the virtues, those positive qualities. Furthermore, I would suggest that it is a win-win if we have those. If we don’t have those, we will mess up our lives and we will mess up other people’s lives. I’d suggest that it’s a win-win between happiness and ethics, between having a positive pleasurable life and being a good person. Interestingly, in positive psychology, as you suggested, they’ve rebranded: they do mention the virtues, but they’ve rebranded them as character strengths, and they’ve actually got six virtues. They did a literature search, a very extensive one, and they agreed with the Stoics (and Plato as well) about those four cardinal virtues, but then they added two other ones: humanity — which I’ve bundled up into justice, which I think is fair enough; I think the Stoics did that as well — and then they’ve got one called transcendence, which is all about connecting with the world outside ourselves — but I would argue that that’s probably a consequence of all the other ones: you’ll find meaning if you do these things. So it’s not just me saying that these things logically sound like they’re good qualities. There is actually evidence that these character strengths are beneficial to our own wellbeing and health and effectiveness and being a good member of the community. So that’s the second pillar of Stoicism. Rob Wiblin: What’s the third one? Tim LeBon: The third one is therapy of the emotions and Stoic mindfulness. Which will sound familiar, having heard about what CBT is, but it’s specifically noticing. So there you are, you’re in the car and someone’s cut you off, say. It’s noticing the judgements that you’re making particularly — it’s a bit different to a general mindfulness where you’re noticing everything that’s going on — it’s specifically noticing the judgement, and then choosing what to do with those thoughts. Because it connects with the dichotomy of control: we haven’t got control over our initial thoughts, like whatever “expletive deleted” comes automatically into your head, but we have got control over our response to it. Similarly, we haven’t got control over our initial urges, but we have, to some extent anyway, got more control over what we do with those urges. The CBT therapists have then developed that into the procedures that I described earlier, like STOPP and cognitive restructuring. Epictetus in particular has some nice phrases, like, being like the night guard or the gatekeeper, who doesn’t let in the thoughts without examining them closely. You can think of that either as a kind of mindfulness — of just noticing them and having a sort of detachment — or you can have the idea of actually challenging them. And when you’re doing the Stoic version of therapy of the emotions, you can incorporate all of those CBT tools we talked about earlier. There are also some interesting Stoic twists to it, which would include the idea that the main thing that matters in life for the Stoics is being a good person. That is what matters most — all the other things in life are either preferred or dispreferred, but they’re kind of in a second division. Rob Wiblin: What are the secondary things that also matter, but not quite as much? Tim LeBon: Well, it’s not “not quite as much” — actually, it’s like in a game of cards, it’s like they’re trumps — the virtues are the things that matter and they trump anything else. And, well, it would be all the normal things we think matter: health and status, what other people think of us, all those things. That can be quite helpful if you buy into it, because then it’s like, “OK, this person, or this train company, has just offered me a challenge, because I can actually build my practice of being patient or being kind in how I respond to this. The fact that I feel that I’ve been disrespected actually doesn’t really matter because what matters is me responding with a positive quality.” These adversities, you can actually turn them around to being positive things. Rob Wiblin: I see. A convenient thing for someone with this Stoic attitude to what is a good life is that any adversity simply allows you to cultivate even greater virtue — to have the ability to overcome challenges and be virtuous nonetheless, which is the paragon of a good life. Tim LeBon: Seneca puts it in that way, yeah. Rob Wiblin: Why use virtues? I mean, you could have said that you need to stop and think about your feelings, and you need to distinguish what things you can change and what things you can’t. But then, having figured out what you can change, you should do the best thing. You should analyse it and do the best thing, or you should follow these particular rules of how you want to behave. But instead they’re using this heuristic of whether you’re displaying these particular positive qualities as the way of figuring out how to act. Is there a theory behind that? I know within the kind of philosophy that I’m familiar with, there’s a particular reasoning for why you would use virtues as your decision-making process, but do you want to expand on that? Tim LeBon: If I can approach it from the other direction? The problem with act utilitarianism is it’s very new-brainy. Rob Wiblin: And “act utilitarianism” is the style of utilitarianism where with every individual act, in theory, you say what specific choice, what specific action in this situation would produce the best outcome — the best expected consequences, all things considered, for all time. This is often contrasted with rule utilitarianism, where rather than try to figure out the best action in a specific situation, instead you look at a lot of different situations and say what general principles of action would, on average, across a wide portfolio of choices, lead to good outcomes. Of course, that’s more easily computed because you don’t have to go through this enormous calculation in every specific case. Instead, you end up with rules of thumb, like don’t steal, or whatever else that you think is generally conducive to good outcomes. Yeah. Do you want to take it from there? Tim LeBon: Yeah. One of the problems with act utilitarianism, taken in a kind of very crude, naive way, is that, as I said, it’s very new-brainy: you’ve got to actually kind of take a step back, and then you’ve got to try and calculate the consequences. There’s several problems with that. One is we might be self-interested and not doing it in a very fair way. Or might go to the opposite extreme and think we’ve got to be self-denying, actually — which seems to be what some effective altruists take — which is not really implied by utilitarianism, but some people think they effectively count for nothing. Or we just might get into a problem where we haven’t got time to calculate, or taking the time is actually self-defeating. It’s a bit like someone playing chess, where you’re just trying to calculate everything and you run out of time. So R. M. Hare, who I studied back in the day, came up with the idea that there are two levels of moral thinking. One is the critical level, which is where utilitarianism arises, and that’s where you decide what your rules are. He tended to think of it in terms of rules, but you could also say that’s where you decide what the virtues are, and what those virtues actually look like in practice. You do this when you’re cool, calm, and collected and have lots of time: you think about what the rules should be and what the virtues should be, and that’s your critical thinking. Also you might do it in really problematic cases, where the rules conflict or the virtues conflict. That would be what Hare would say anyway. But then most of the time, you’re on autopilot, because you really internalise these rules or virtues. Most of the time, you’re in what he calls “intuitive thinking” and what Kahneman and Tversky would call the “fast thinking” and what Greene would call the “automatic” mode. I think that fits quite nicely with what we know about the brain and neuroscience: that actually we want to be in that system most of the time, because that’s what we seem to be programmed to do as human beings. Rob Wiblin: Yeah, everything else is a lot of effort. Tim LeBon: Everything else is a lot of effort, and it won’t be very reliable to do, and we’ll rationalise it in a bad way unless we’re doing those STOPP-type things really well, et cetera. Now, why choose virtues as the primary thing? I wouldn’t say rather than rules, because you can still have rules within a main virtues ethics framework. I think there’s two reasons. One is that virtues are dispositions of character, so they include a motivational element. So to be fully virtuous, actually, you’re not quite doing what we said earlier. You’re not generally doing a STOPP. You’re not generally saying, “I’ve got to deal with these unhelpful automatic thoughts. I’m going to have to take a breath and I’m going to have to decide what’s best. I’m going to have to challenge my initial impulse. And then I’m going to, with great effort, do the right thing.” Once you’ve progressed, you will have internalised those virtues. That’s the idea, is that these become old-brain, system one, automatic dispositions of character. So you automatically want to do the courageous thing, want to do the moderate thing, want to do the just thing, want to do the wise thing. They are not so effortful and there isn’t this kind of conflict going on. That’s the ideal. Now, the Stoics weren’t so stupid that they thought that this was actually how all human beings were. They had this idea of a concept of the sage. The sage is this fully developed, rational person. Like in that quote from Marcus Aurelius, a person actually lives and breathes that the whole time, right? Rob Wiblin: A fully enlightened person. Tim LeBon: A fully enlightened person, as in other traditions. Now, they thought that the sage actually only comes along perhaps once every few hundred years. So it’s an ideal. There is also an idea in Stoicism that we can work towards the sage; there’s this concept called oikeiôsis. Rob Wiblin: You’ll have to translate that for me. Tim LeBon: Well, it literally means, I think, “appropriation” or something, but it doesn’t really make much sense as a literal translation. What it kind of means is developing from this very selfish, irrational creature that we might remember ourselves being when we were younger, and hopefully not so much now. Rob Wiblin: Someone who’s more like a child or animal. Tim LeBon: Yes, exactly. To someone who is fully human, in the sense that we have this capacity for benevolence and rationality. And that’s where we’re working towards. If we are really getting there, it’s not just a case of forcing ourselves to be like that. We’ve really internalised it. So that’s another reason why I think virtues ethics is quite appealing, because it goes with the idea that it links with motivation, and it links with what you’re disposed to do. You might have rules, but actually you don’t even have to initially refer to them. It’s like you just tell the truth because that’s what you feel like doing. I think we can identify with it, can’t we? When we think about things like telling the truth generally, that’s what we do — there’s no great internal conflict. The idea for the Stoic is that we’re like that with all of these qualities. And remember, we said earlier that these qualities, I think, can in general be win-wins between us being happy and us being good people. We talked about positive feedback loops when we were talking about those negative cycles about perfectionism and low self-esteem. We can talk about there being a nicely named virtuous positive cycle whereby we cultivate the virtues, we’re honest in our relationships. In general, we’ll get positive feedback from that — and so we’ll be more disposed to do it in the future, and we tend to live flourishing lives. This might sound a bit like a fairy tale, but again, positive psychology — although it hasn’t necessarily connected that much with Stoicism yet — it’s certainly done research on the virtues, and there is evidence. There’s research like random acts of kindness benefit the person that does them as much, if not more than, the person that they’re done to, et cetera. Rob Wiblin: Yeah, the way I think about it is that the dumb naive thing, some base layer, is that with every case you have to compute it specifically and figure out what the right action is. Obviously that’s unmanageable. So then you want to go up higher to some level of abstraction or generalisation. Say, considering a lot of different scenarios and averaging across them, what principles of behaviour could we come up with that would be conducive to good outcomes or to the right sort of actions? But you might even think actually there’s going to be too many of those, and even that’s too specific and a bit too prescriptive. We need to go up to a higher level and say even what dispositions, what general ways of living, what general automatic responses would be conducive to taking good actions across the board? That’s where I think of virtue ethics as falling: as an even higher level of abstraction of, “What would a person who generally produces good outcomes be like?” In a sense, you’ve given something up by generalising to that degree, but it seems like it is what works. If you actually wanted to ask what would be a good way to think about your life on a day-to-day basis, or what is a practical way of living a moral life, I think thinking about virtues most of the time is better — both because it’s somewhat specific and a bit flexible, and it’s calculable so you can spit out an answer more intuitively about, “Am I acting according to the virtues that I have specified a good person would exhibit in this case?” Or “What action would be a good mixture of wise and courageous?” and so on. And it’s also way more motivating. I mean, when you think about rules, often they seem constrictive and irritating constraints on your behaviour. Whereas virtues are more appealing, because you’re thinking, “Actually, I want to be a wise person. I want to be a courageous person. I want to achieve justice.” I think it’s a more positive, action-orientated way of thinking. At least to me. Tim LeBon: Very well put. Love it. You’ve converted me. Rob Wiblin: I’m not super knowledgeable about Stoicism, but I’m something of a fan. Actually, one of my favourite YouTube videos that I’ve watched literally dozens of times is a description of Stoicism from The School of Life. Have you seen this one? Tim LeBon: I think so, yeah. Rob Wiblin: It’s got some lines in it that have really stuck in my mind. One of them is this quote from Seneca, I think, that was like, “What point is there in crying over parts of life? The whole of it calls for tears.” It’s a little bit dark, but when bad things happen, I find that very comforting somehow. Life is just full of terrible things that happen, and it’s kind of an absurd joke on all of us, so why highlight the specific bad thing that happened today? It doesn’t stand out in the scheme of things. Tim LeBon: What attitude can you take, to laugh or cry? Rob Wiblin: Yeah, exactly. I just want to bring up some other things from that video that I understood as being related to Stoicism, but that you didn’t mention. One is this video talks about how the Stoics thought that one reason that we have negative responses to things, or things that are counterproductive, is that we have naive expectations about the future. We tend to think we shouldn’t be stuck in traffic, like, “Traffic shouldn’t exist. I should generally get to things on time and not face impediments.” And “People shouldn’t be rude to me. This isn’t the way that the world ought to be.” Then these “ought” expectations are constantly foiled by reality because the world is, in fact, much worse than that and not optimised, and problems do exist, and we are going to confront people who are rude. But this conflict between these peculiar expectations and reality then generates negative reactions. I think the Stoics generally suggest that we should maybe be a little bit pessimistic. Was it Aurelius or Seneca who said that when you get up in the morning, don’t expect things to go great. Expect betrayal, expect a tragedy. Expect everything to go wrong, and then you’ll feel great no matter how the day goes. Is that right? Tim LeBon: Well, it’s my favorite passage in Meditations. Aurelius says, when you wake up in the morning — I’m paraphrasing — remember that you’re going to meet people who are ungrateful and rude and envious. But then it goes on, because it’s not just about lowering your expectations — but you’re absolutely right, lowering your expectations is an important part of it. Because if we have unrealistic expectations — because it’s not even pessimism, it’s just realism, actually — I think that’s important to note. Because it’s true. It’s true sometimes. Rob Wiblin: People will betray you. You will lose your job sometimes. Tim LeBon: Yeah. These things happen, and are quite likely to happen to some extent. So it starts off with the expectations part of it, but then it’s, “But I can choose my response to it. They might be like that, but” — and this might sound, I don’t know, superior, but it’s kind of like — “I know better. I know what is good and I know that what matters is just me being virtuous, which is part of the Stoic value system. So I needn’t let it bother me.” And furthermore — I’m very much free flowing the paraphrase here, but the way I like to put it would be: “We’re all in it together, we’re all human beings, and it’s kind of inhumane to be angry with them. So I should forgive these people and actually embrace them as my fellow human beings.” Rob Wiblin: Tall order sometimes. That’s a lot. Tim LeBon: You could say that that bit of Meditations is just kind of “Wake up and expect bad things to happen.” But it’s much more than that, because it’s the whole of Stoicism, really. It’s separating what you can control and what you can’t control, and then having a positive attitude to it. Which is partly forgiveness, but partly a real kinship and camaraderie with your fellow human beings, even those that tend to, say, “haven’t seen the light yet” — which is probably more a Christian kind of phrase. But there is that kind of tone in Marcus 2.1, for sure. So you’re absolutely right. I think Alain de Botton did a TV programme — actually, he wrote an excellent book called The Consolations of Philosophy and then he did a Channel 4 TV programme. He has a hilarious clip where he tries to do Stoic therapy on a white van driver in London and says to him, “Are you an optimist or a pessimist? You’re an optimist, you gotta be.” He tries to convince Wayne, the driver, to have lower expectations, and it doesn’t go all that well. Rob Wiblin: I see. That’s interesting. If I recall, one of the arguments that the Stoics in this video made was that people would say, “I get angry and frustrated because I’m a passionate person.” They said, “No, you get angry because you’re an idiot, because you’re forming these false expectations. You’re constantly expecting things to go well, even though all of your past experiences suggest that things will go a mixture of well and badly.” I guess that fear of being seen as foolish might motivate people to reevaluate what they expected. Tim LeBon: Yeah, it’s kind of shock therapy in a way. Seneca wrote a lovely little book called On Anger, which is like a really good self-help manual for anger. And this is what was lost on Wayne the driver: Seneca spends a lot of time on the pros and cons of anger and why anger is such a bad thing, whereas Wayne the van driver seemed to just get out of bed to enjoy being angry at his fellow drivers. He didn’t quite see why it was problematic. Rob Wiblin: I suppose if you actually were enjoying it, then maybe there is something to be said for it. I would say most of the time I don’t enjoy being angry. Well, it’s a very mixed emotion, anger. Because on the one hand, it is unpleasant. On the other hand, it’s so delicious, because you feel the sense of just rage at other people wronging you. There’s something very appealing about it. Tim LeBon: Yeah. Well, we stand on the high ground: We’re right; they’re wrong. We don’t have to open up to the possibility that we’re in the wrong. It feels good to judge other people. So you could do pros and cons of anger, like pros and cons of perfection. We’d see there’d be some payoffs, but for people who’ve got a problem with anger, some severe disadvantages. Now, we might come on to some things that are problematic in Stoicism later, but I will just say something here: there are some people that have the opposite problem. We were talking earlier about how for everything, it’s got to be the right person to match the right treatment for. There are some people who have a problem with not getting angry at all, and then it’s kind of suppressed. It wouldn’t be a suitable treatment for them to say, “Don’t get angry.” Actually, what would be helpful for them is to come much more in touch with the parts of them that are concerned for justice — rather than being suppressed, to become much more in touch with those parts. It still wouldn’t really be anger; it would come out as concern for myself and something like assertiveness. So it’s not like the Stoics are wrong with their message that anger is a bad thing in general, but it’s not a helpful message for some people, where they’ve got the opposite problem of kind of subjugating their own needs. Does that make any sense? Rob Wiblin: Yeah, completely. I guess one way to avoid getting angry is to avoid even being aware of what you want. You sublimate your true feelings about something. Even if that doesn’t come out in some distorted behaviour, it means that you’re potentially not sticking up for or communicating the things that you actually care about. Tim LeBon: Exactly. Rob Wiblin: An objection one could make to thinking about things in terms of virtues is, well, there’s many questions here. One is like, how would you figure out what the appropriate virtues to value are? That could just be a very difficult thing to figure out. Also, which virtues should you be highlighting in any particular decision? That is somewhat left unclear. It sounded like the Stoics, they have the four cardinal virtues and then some other virtues. Maybe those are the wrong ones; how would we know whether they were the right ones to choose? Tim LeBon: Well, I think that almost existential argument that I made earlier, about those four virtues addressing the human condition, persuades me anyway. I don’t want to own that argument because my colleague, Chris Gill, said something very similar that I’ve kind of based that on. Martin Seligman, in the positive psychology movement, did a very large literature review of philosophy, religion, and societies, and found out that these were fairly universal — and then divided them into actually 24 strengths, which are like these mini-virtues. There were certain criteria that they adopted, like: Does this in general tend to nourish people? Does it tend to help other people? Things like hope got included for that reason, and humour. Obviously we can debate as to whether humility, for instance, is a virtue or vice. In terms of what the key virtues are, I think one can make a fairly strong case. Also for these kinds of sub-virtues or mini-virtues or qualities; I think one could say that it’s pretty clear that, say, patience is in general a good thing. What the Stoics said, helpfully or unhelpfully, is that wisdom is like the master virtue; wisdom kind of mediates all the others. So is optimism always a virtue? No, of course it isn’t. If you’ve got a pilot, and they’re very optimistic, and they hear a rattling noise, you don’t really want them to be optimistic about it. Rob Wiblin: It seems like for some virtues, it’s about hitting the sweet spot in between two other extremes. Tim LeBon: That’s Aristotle’s theory of the mean. Stoics don’t have the theory of the mean, but they would say, “it’s what the person of practical wisdom would decide” — which sounds a bit circular, but it is the idea that if you’re trained and experienced, then you just understand that if you’re a pilot of a plane, this is not something you should be optimistic about. Again, I’m not sure it’s the complete answer, but one of their things would be: you think of a role model, and what would they do in this situation? The Stoics would actually imagine that Socrates was one of their role models, who they thought was a bit of a sage. So what would Socrates do in this situation? How would Socrates think about it? That would be one of their ways of deciding. The strength of it is it’s very context dependent, which I think is a good thing. Like you were saying, with your different degrees, you actually want something that is very general, but at the same time isn’t just a rule that applies all the time. The weakness is it doesn’t always tell you what to do. Rob Wiblin: It’s not very deterministic. Tim LeBon: It’s not very deterministic, which is why virtue ethics needs something like utilitarianism as the theory that you go to to decide what the virtues are. So it’s not just that the human condition says that; it’s actually, if we develop those dispositions, then it will lead to greater happiness for us and other people. So there is some consequentialism embedded in Stoicism, but it doesn’t highlight it. Rob Wiblin: Right. Because if you had no view on what was a good outcome, then for example, what if creating a horrible world where people were miserable was the desired outcome? I guess the virtues that they’re choosing probably aren’t conducive to that. It seems like, to some extent, there’s consequentialism embedded in the choice. An interesting example where it’s just too nondeterministic would be: rather than ask “Which charity helps people the most?,” GiveWell, this charity evaluator, could instead ask, “What charity would a virtuous person give to?” I think that’s an example where it just doesn’t say enough. “What would a courageous person give to?” That’s a case where thinking about what a virtuous person would do does get you to think, well, they would use some of their resources to benefit others inasmuch as they were in a position to do so. But then you need a different decision-making procedure to think about which of these organisations will help people the most. Tim LeBon: Exactly. Generally this is a second problem with Stoicism, potentially — well, in ancient Stoicism — is that it’s indeterminate. And worse than that, the utilitarians seem to have got a lot of the right answers, and the Stoics didn’t necessarily get the right answers to things like: How do we treat women? How do we treat slaves? How do we treat animals? Then we’ve got people like Jeremy Bentham being one of the earliest people in modern times to argue for gay rights; we’ve got Mill arguing against how women were treated; and we’ve got people like Peter Singer arguing that animals are treated much better. So it seems like utilitarianism gets the right answers. And I think one problem with a virtue ethics point of view is it can lend itself to a… Rob Wiblin: It’s almost too flexible and too vague. You could rationalise bad actions. Tim LeBon: Yeah. And you can rationalise the status quo: “It feels right.” And you take your role model to be: “That person that’s like a role model, they keep slaves. So we should keep slaves.” So what utilitarianism and consequentialism asks us to do is to really think about happiness and suffering — thinking about, “Do they suffer? Can they have the potential to be happy?” — and that’s what matters. So at one level, actually, experiences are prioritised in utilitarianism, whereas they’re definitely not in Stoicism. Rob Wiblin: Oh, really? You were saying that the Stoic vision of a good life was a virtuous life, one where you exhibited these positive qualities. Whether you had a good time or whether you were suffering wasn’t really the issue. Tim LeBon: Exactly. Rob Wiblin: I see. It didn’t have the wellbeing-focused elements. Added note from Tim after the recording: “Not directly, although the Stoics did think that being a good person would, as a positive spinoff, make you happy.” Rob Wiblin: That’s interesting. Weren’t there other schools of thought? I mean, I think some ancient philosophers were really concerned with it. I guess I’m thinking of the Epicureans, among others. Tim LeBon: So the Epicureans were the opposite. They thought virtues were important but purely instrumentally, and they believed that pleasure was the sole good. But what they meant by “pleasure” was actually ataraxia, which is kind of like serenity or the absence of anxiety — so they had a slightly strange view of what pleasure was. But they said that’s what you should be solely concerned with. They were kind of like utilitarians without the social conscience side of it. Rob Wiblin: More egoistic. Tim LeBon: More egoistic, but then again, they thought that friendship was an important part of flourishing, so they’d be nice to their friends. But you can imagine an Epicurean not being so bothered about famine or something like that. So Epicureans seem to have got some things right, but some things wrong. I think Stoicism provides a very good practical philosophy, partly because what we were saying about the virtues as being, in practical terms, motivating — and meaning that we don’t have to do all this kind of calculation the whole time. The dichotomy of control, I think, makes just very good logical sense as a kind of heuristic. And then it’s also got this therapeutic element, which helps us be very resilient. So if we’re interested in the impact we make on the world… And I forgot one of my favourite CBT analogies, which is the oxygen mask. When you go on the plane, when they say if there’s a failure in oxygen, even if you’ve got little ones with you, whose oxygen mask do you put on first? Your own. Why? Because if you don’t look after yourself, you can’t look after anyone else. The same thing I think goes for everybody that’s concerned about the impact they make on other people. If you don’t look after yourself, you’re not going to be in a good position to help other people. That is something that I’d often talk about with moral perfectionists and perfectionists in general. The lovely thing about Stoicism, and why I’m such a fan of it, is that it does very much help us to think about our own mental wellbeing and look after ourselves to be resilient, as well as having that moral compass, which is the virtues. The idea would be instead of phrasing it as “doing the most good you can,” it would probably be “be the best version of yourself that you can be.” Rob Wiblin: I guess that highlights another aspect of what’s nice about the virtue framing, and is challenging about the consequentialist framing, which is that you have more control over the characteristics that you display than the consequences that you cause. It’s possible most of the time to be kind on any given day, but you can’t actually make it be the case that your project goes well or that you benefit people, all things considered. Maybe that’s another way in which it’s more motivating: if you’re trying to found a business and have it be super successful, there’s just no way you can guarantee that that’s going to be the case. But you can have been a good colleague while you’re doing that. And so the fact that you are more likely to be able to succeed at your goal, I think makes it more appealing and gives you less of a sense of dread. Tim LeBon: Exactly. In modern terms they might talk about “process goals” as opposed to “outcome goals.” You’re focusing on the process goal, which is a process of being virtuous or doing the best you can. The Stoics also have this lovely analogy of the archer. As an archer, it’s outdoors. There might be wind. What is under your control is you can prepare, you can take aim carefully, and you can fire. But then the wind may mean that you miss your target. Or the animal might move, if you’re aiming at an animal. So what is the best attitude of the Stoic archer? It’s to be very diligent in terms of their preparation and concentration, et cetera. But once they’ve fired the arrow, to really let go of their attachment to the outcome, because it’s outside their control. Obviously they would like it to hit the aim, but if it doesn’t, they’re not going to get into a whole self-flagellation cycle, because it’s outside their control. “I did my best. If I didn’t do my best, I’ll learn from it.” It links with what modern psychologists call the “growth mindset”: if you fail, you learn from it. For Stoics, it would be a case of focusing very much of what is under your control and letting go of concern for the outcome — which I think is something that means you’re going to have a better state of mental health, because you’re not going to go into the worry so much, or the rumination. Rob Wiblin: So Marcus Aurelius wrote the Meditations, right? The kind of classic summary of this general philosophy or approach to life. Didn’t he write that while he was engaged in an imperialist war against other groups, trying to subjugate them to Roman rule? Tim LeBon: Well, that’s one way of putting it. Another way of putting it would be that the Empire was under attack and it was a defensive war. Rob Wiblin: Yeah, I guess I was thinking that slightly highlights that it’s possible, I suppose, to have very strong control over your own emotions and try to learn from things. But there is something lacking from this worldview, potentially, because it maybe doesn’t have enough to say about what is a just world, all things considered, and what should we be trying to do for others far away? Tim LeBon: I think there’s a really interesting discussion to be had about the gung ho utilitarian view and the gung ho Stoic view, or virtues ethics view, because the Stoics would talk about roles and duties. So his role was emperor and so you could say his duty is to lead the army. Versus the kind of impartial spectator view of the world and saying, “Hold on, are you the good guys?” Rob Wiblin: “Maybe he should have joined the other side.” Tim LeBon: “Is war a good thing? Those people are human beings that you’re killing.” I think that the strength of utilitarianism, especially when we’re talking about women and slaves and animals, et cetera, is that it forces us to take that view, it encourages us to take that impartial view. Although Marcus Aurelius and other Stoics talk about how benevolence is part of the virtues, it doesn’t really prioritise it, and it’s very much focusing on, “What are your roles? What are your duties?” There’s also, I think it’s worth mentioning, a lovely parallel between Stoicism and something that Peter Singer’s written. Listeners might be familiar with Peter Singer’s book, The Expanding Circle, and the idea that we can expand our concern from ourselves, to the wider community, to the world in general, to animals, et cetera. And that would be a good thing to do, and maybe as time has progressed, that’s something that humanity has done more and more. When I read that book, I loved it. But what I discovered later was that a Stoic writer — who came about a century after Marcus Aurelius, very much at the tail end of when the Stoics were in their heyday — called Hierocles came up with this idea of the circles of concern, which are a series of concentric circles where you are in the centre, then it would be your family, then it would be your colleagues, then it would be fellow citizens, then it would be people from other parts of the world. That’s as far as they took it. Modern Stoics have wanted to include animals and the environment, et cetera, as well. But the idea would be that you would contract the circles towards you, so you would treat people further out in that circle as being like you. You would, for instance, call a colleague “brother” or you’d call an aunt “sister” — which I guess you get in some religious circles, where you call everybody “brother.” It’s that kind of idea. Rob Wiblin: Or “comrade.” Tim LeBon: Comrade, yeah. You treat people that are further from you as if they were close to you. Some modern Stoics have turned that into a meditation, where you kind of imagine doing that, which is a bit like the Buddhist loving-kindness meditation. It’s lovely parallels between utilitarianism, Buddhism, and Stoicism, all with this idea of extending benevolence outside oneself. And we talked about that strange word oikeiôsis earlier; it would be part of that journey whereby you recognise that naturally probably we’re conditioned to think of ourselves and our kin first. We have the ability to develop the disposition to care more about other people. In that way, we would become more naturally virtuous as well. Rob Wiblin: OK let’s double back and get a bit more detail on what Stoicism was as a set of ideas in antiquity. Can you give us a richer picture of Stoicism in the ancient world? Tim LeBon: Well, how long have we got? Rob Wiblin: Well, I got nothing else to do. Tim LeBon: So, ancient Stoicism was quite a complex system which embraced logic, physics, ethics, psychology, worldview in general, everything. And Chrysippus, who was, I think, the third head of the ancient Stoic school, wrote volumes of work. You get people like Seneca, who was a later Roman Stoic we’ve been talking about, [but these earlier Greek Stoics like Zeno and Chyysippus] wrote all these volumes of works, and they are now almost completely lost. So the truth is, we get secondhand accounts from Zeno of Citium, who was the original person that founded Stoicism. He wrote a really big book called Republic, which was something that was in opposition to Plato’s Republic — which sounds, by all accounts, as if it was very much in the same vein as John Lennon’s song “Imagine” — a real kind of socialist utopian republic, as opposed to Plato’s elitist rule of the wise. So that’s not what we think Stoicism is, is it? So that’s what Zeno thought. Wow. But that’s all kind of lost. Rob Wiblin: I guess we don’t want to get too stuck on the historical side, but am I right in it sounds like Stoicism was less the views of one guy called Stoic or something? It was more like a school of thought at a university or a school of thought in academia, where all sorts of people were contributing? Tim LeBon: Yeah, and that’s really important. There is no one universal Stoicism, and they disagreed with each other. You’d get people who said, “Hey, we’ve got to emphasise this bit,” or, “Hey, that bit’s wrong.” So that is very true; that means that everyone has their own Stoicism. Before I get onto my own version of Stoicism, which — Rob Wiblin: — is the best. Tim LeBon: I was going to say, people wouldn’t universally agree with it, which is certainly true. But obviously it’s the best, yeah. But there’s Roman Stoicism as well. Again, without going too much into the history, the Greeks had this very complex system, which had their own system of logic — “philosophical logic,” we’d call it now. Then it kind of migrated to Rome a few hundred years later — this would be around the time of Christ’s birth, just a bit before, a bit after — and it really flourished in Rome. The Romans, of course, as everyone does, took the bits of Stoicism that they liked, and they particularly focused on the ethical part of it. So the Roman Stoics are much more interested in the ethics than the logic or the physics. Although it wouldn’t be true to say that they completely ignore those, but they emphasise the ethics. They also emphasise the psychological aspects, which is why… This is probably worth mentioning, since we’ve talked so much about CBT. So before CBT there was, as everyone knows, psychoanalysis. And there were a bunch of psychiatrists and psychologists who were getting a bit dissatisfied, or more than a bit dissatisfied, with psychoanalysis — because there are all these people who were doing lots of psychoanalysis and weren’t necessarily benefiting from them. Rob Wiblin: Or indeed, being harmed sometimes. Sorry, go on. Tim LeBon: A couple of these were Albert Ellis, who started a therapy called “rational therapy” originally, but then it became REBT. Which is quite interesting: it started off as purely rational, and then they added the emotional and the behavioural because they found that they needed that. And then Aaron Temkin Beck created cognitive behavioural therapy. It’s a bit confusing because cognitive behavioural therapy is also an umbrella term for a whole batch of therapies. But there’s Beckian CBT. Beckian CBT is the bit that is particularly popular in the NHS. It’s got the most evidence, and it’s the brand of CBT that I specialise in. But anyway, these people in the 1950s, 1960s read Marcus Aurelius and Epictetus and other Stoics, and they were particularly struck by Epictetus very early on in his Handbook. Who knows how far they got in reading the Stoics, but it’s quite early on where he says something like, “It’s not events that disturb us; it’s our interpretation of events.” So it’s not the thing that happens, the event; it’s how you think about it. They then ran with that. Instead of sitting for many hours talking about their childhood — sorry, for psychoanalysts listening, I know that’s a caricature of what you do — Beck and Ellis created a much more active, directive, focused therapy, which we described earlier. So you start off with the idea that how you think affects how you feel, and also what you do affects how you feel. And that’s CBT, essentially. Then you focus on what’s going on in the present, rather than so much in the past. Although, as we’ve seen, the past can be relevant. And then, just to kind of differentiate CBT from Stoicism, because they’re not the same: Stoicism sowed the seeds for CBT, but then CBT has gone off, particularly Beckian CBT, to be very disorder-specific. So for each of those disorders — like OCD, social anxiety, various types of depression, et cetera — there is a particular kind of protocol treatment manual, model, the maps. And it’s because of that that you get all the evidence. REBT has gone off in a slightly more philosophical way, actually, to kind of think about what sort of healthy beliefs to have. Anyway, without going too much into the differences, Stoicism has had a lot of indirect influence via CBT, which is one of the reasons why I find Stoicism so interesting. Now, I realise that I said there were two answers to your question. That’s the first bit, which is talking about ancient Stoicism. You’ve got your Greeks, you’ve got your Romans who are more into the ethics and more into the very practical side of it. You’ve got Epictetus, who is writing this… Well, actually, he didn’t write it; it was a student of his who wrote the Handbook or Enchiridion — which is quite a short little book, basically a kind of self-help book really, about how to live a better life, how to be more resilient, how to be calmer and more serene, et cetera. Which is why it spoke so well to generations of people afterwards, including psychologists. Now, Stoicism has had quite a big influence over the years. The Victorians were quite into Stoicism — but again, they reinvented it in their own way, and they probably turned it a bit into a stiff upper lip version. You’ve got intellectuals and philosophers in the Enlightenment — like Spinoza, Descartes. Even people like David Hume and Adam Smith — who were not necessarily obviously Stoic — kind of read the Stoics, and they were influenced by them and quite liked bits of them. So Stoicism was an interesting little, I don’t know… Rob Wiblin: Part of the oeuvre. Tim LeBon: Yeah, exactly. But to be honest, when I studied philosophy back in the day, Stoicism didn’t have a very good reputation. I studied Ancient Greek philosophy, did some Aristotle, Plato. As for the Stoics, there was no course on the Stoics. If I’d wanted to do them, I couldn’t do them. Although Stoicism has this history, it kind of faded away a little bit, in terms of its popularity, except for being taken on by the CBT people. Rob Wiblin: If any listeners are interested to get a bit more Stoicism in their life, take some steps towards thinking in this way, what could they do? What would you recommend that they read? Tim LeBon: Well, I hope that my book, 365 Ways to Be More Stoic would be helpful. Rob Wiblin: It’s a lot of ways, yeah. Tim LeBon: It’s a lot of ways. But the idea of the book is that it’s a kind of guided discovery. We talked about guided discovery earlier, where you start off with something very uncontroversial. Like [the example in the book describing the] dichotomy of control starts off with sports, where it’s a bit of a cliche to control the controllables. Then it goes on to talk about how it applies to managing worry, for instance, because worry is actually about thinking about stuff that you can’t really control. And ideas like the Stoic archer. And also, it’s my own blend of Stoicism, because I’ve tried to kind of integrate it with positive psychology and CBT. So, for instance, there’s a chapter on each of the virtues, and then it’s drawing on contemporary evidence-based ideas about how to develop self control, how to develop courage, et cetera. If I’m allowed a little bit of self-promotion, I do hope that if people like the way I’m talking about things, then that might be a place to go. But In terms of the ancient Stoics, there’s really three. As I said, a lot of the ancient Stoics have been lost in terms of their writings. Epictetus’s Handbook or Enchiridion and Marcus Aurelius’s Meditations are both very readable. Seneca wrote humongous amounts, but his stuff on anger is good. His short essay On Anger and also his short essay On the Shortness of Life, which is like an early manual on time management with a Stoic twist to it. So those are the big three. There are also contemporaries, colleagues in the modern Stoic movement, such as Donald Robertson, John Sellars, Massimo Pigliucci, and others who have written very readable introductions to Stoicism. So there’s plenty out there if people are interested in it. Rob Wiblin: Nice. Well, we’re getting close to the end. It’s getting a bit late on a Friday night. We should let you get back to your family. The last section I wanted to do was to kind of map out any important advice that you would have for listeners regarding mental health that maybe didn’t come up earlier. I mean, we just know that there’s so many people struggling with depression or anxiety or various other challenges that reduce their wellbeing or make it harder for them to achieve the goals that they have. Are there any high-level messages that you would want people to walk away with? Tim LeBon: I think the first thing is courage. It takes courage to say to oneself, “Actually, something’s not quite right here.” It takes a further step of courage to actually seek support from someone else. I would see it as an act of strength to seek support, and also wisdom. That would be the first message: don’t suffer in silence. The second message is that help is out there. You might get it from listening to a podcast. You might get it from reading a self-help book. I mentioned Melanie Fennel on self-esteem. Roz Shafran is the coauthor of some books on perfectionism, for instance. Rob Wiblin: Yeah, I read one of those. It’s very good. Tim LeBon: David Burns was one of the oldies for writing Feeling Good and The Feeling Good Handbook. Christine Padesky, who I mentioned, would be some of the older generation of CBT self-help writers. But they’re still very good books, so a lot of people can be helped by those books. They can also, if they’re in the UK and eligible for the NHS, reach out to what’s now called NHS talking therapies to avail themselves of CBT, or reach out to a private therapist if they wish. I know on 80,000 Hours there’s advice about how to seek a therapist, and I’d endorse those things like try and find a good fit for you, someone who you feel is the right chemistry. We also talked about perhaps going to a GP as well to rule out there being a physical element of it in some cases, and considering medication as well. The number one tip is to take it seriously. Number two is to remember that help is possible — and if we’d been having this conversation 30, 40 years ago, that would have been less true, because CBT was less developed, less available, and the form of therapies that were available weren’t necessarily quite as helpful. Rob Wiblin: You think the process of refining therapeutic methods is actually causing these treatments to get better and better over time? Tim LeBon: Yes, I think it’s progressing. And it might be a bit confusing, because we talked about Stoicism, we talked about CBT. I think my mantra for that is: CBT if you’ve got a mental health problem, Stoicism for resilience, and a kind of a preventative thing that will help you reduce the chances of developing a big problem, and also Stoicism for relapse prevention. If you’re kind of better, then Stoicism might be good. That’s the way I think about it. If someone comes in, if they’ve got a mental health problem, then I’d go for CBT, and if they’re in a kind of a better phase then it might be more drawing on Stoicism. Then we’ve also got utilitarianism, utilitarianism and Stoicism, and then the idea that utilitarianism is something that we can use to think of what virtues or rules we should have. But that’s just when we go into manual mode, and we’re probably better off programming ourselves to have the right automatic mode — and for that, I would argue that virtue ethics and Stoic approach is certainly one to consider. Rob Wiblin: It seems like one issue is that there’s so many different treatment options, or so many different approaches that someone might take — at least with most of the most common mental health issues or challenges that people might face. You’ve got medication and therapy, but then there’s a whole menu of different therapeutic approaches, and there’s been many different books that will talk about these issues and have different ideas. Would you say that it would make sense for someone to, to some extent, shop around and keep reading or trying different methods until they find one that resonates with them, because it’s a personal issue? Or do you think it’s more that some things have been demonstrated to work and others not so much? Tim LeBon: I prefer the second answer. Yeah, I would go with the evidence. I enjoyed reading the article you wrote on… what was it? The six worst legal careers? Rob Wiblin: I think it was just the world’s most harmful jobs. Tim LeBon: It’s possible that there are some flaky types of therapy that might hit that list, or maybe number seven. Rob Wiblin: Because they’re diverting people from treatments that work or towards ones that don’t or are harmful? Tim LeBon: Yeah, it’s certainly possible. Although something sounds appealing, it might actually not work. If you find what I said about CBT makes sense, and if CBT is the main evidence-based way of working for the problem that you have — which would be true of many anxiety problems and depression — then I would certainly recommend CBT. Even if someone has written a very persuasive-sounding self-help book that proposes something different. But that isn’t to say that there aren’t other types of therapy that work well, but which they just haven’t found the evidence for. Even within the NHS, there are some forms of counselling that are recommended for various issues. I mentioned compassion-focused therapy and the various third-wave CBTs. The NICE guidelines are quite a good place to go. Rob Wiblin: That’s the UK thing. What does NICE stand for? Tim LeBon: National Institute for Health and Care Excellence. Rob Wiblin: That’s it. Tim LeBon: The NHS information is a good first call. I think it’s being a bit cautious about these other alternatives. They might be very good, but your mental health is quite an important thing. Rob Wiblin: Yes, definitely. Maybe what I was gesturing at is, even within perfectionism, which I guess is a reasonably specific description, there might be different reasons that someone has developed perfectionism. You’ve described that there might be different dynamics that are leading to it, and someone might need to read different articles or books until they find someone who is describing maybe what the pattern of belief or behaviour is that’s causing it for them. Tim LeBon: Yeah, exactly. It’s something that resonates, but then something also which has got some good evidence, and then finding a practitioner whose main qualification is not that they’re able to pull up a good website, but they’ve actually trained appropriately. Rob Wiblin: Other than CBT, what methods of treatment do you think have evidence behind them? Tim LeBon: Well, I don’t presume to know better than the NICE guidelines, so I would look at those. But I think the third-wave CBTs, which tend to include mindfulness and sometimes work on values, are starting to get some evidence. The family systems work is something that I’ve done some training in and I think is interesting. We talk about parts of ourselves. Rob Wiblin: I know a lot of people who rave about that. So internal family systems, it’s this approach of thinking, “In my mind, there are many different kind of conflicting beliefs and intuitions.” I guess sometimes someone can have problems because there’s tensions or conflicts between them that aren’t being resolved peacefully. At a broad level, is that kind of right? Tim LeBon: I actually need to research it to know exactly the evidence base for that. Just speaking from experience, it does seem that that really resonates well with some people, and particularly where people have got quite entrenched messages from their childhood; it seems like it pays them respect. The CBT approach would be to treat everything at the same level, as: “This is a thought; it’s rational or irrational.” Whereas we were saying earlier that people believe these things for good reason. It’s like in the film Inside Out, where really there’s this part of you that we want to give a seat at the table. So when I was talking about anger earlier, the type of person who typically represses anger would probably benefit from imagining a table where Anger gets a seat at the table, and gets their say. You might have Anger, and various other parts, and then you get a part called Wise — which would then listen and try and find the truth in it. In other words, you’re allowing perhaps what might be called an “exile” to be heard and to be integrated into the whole system. I think that’s a really interesting approach. As I said, I don’t know exactly the evidence base of it, but in practical terms, it’s something I do alongside CBT as kind of an extension of CBT. And it’s kind of quite similar, actually, but it seems to validate those parts more, and allow them out into the open in cases where they’ve been suppressed. Rob Wiblin: Well, I guess it’s great that there’s something of a flourishing — or I suppose you could think of it as like research and development — to do with all of these different methods. People keep tinkering with them and changing them and kind of forking them into more specific approaches, and then hopefully trying to test whether they work or not. Tim LeBon: We talked about third-wave CBT, so I hope that Stoicism and this would turning full circle — because CBT came from Stoicism, I’d like to see Stoicism be considered as another third-wave CBT. Listeners might be interested in whether Stoicism has got any evidence base. You mentioned earlier that I’m Director of Research for Modern Stoicism, associated with the Aurelius Foundation as well. We’ve done some initial pilot studies, and what we found is that when people practice Stoicism for a week — I mean, it’s a self-selecting sample; we haven’t done randomised control trials yet — but it does look like their wellbeing increases. They have reduced anger, they have increased resilience. If they do it for longer, then it has bigger impact. You retest them after a few months and it seems to keep its impact if they’ve done it for a month: if they practice Stoicism for a month, you retest them up to three months, and it retains its impact. Also, we’ve developed a Stoic Scale, which is correlational studies. It seems that a lot of the Stoic attitudes and behaviours are very highly correlated with flourishing. We’ve started to collect some evidence that seems to be the case that Stoicism, or at least modern Stoicism, is really beneficial. I’m hoping to be part of that research, although I’m a therapist, not a researcher. But if there are any researchers out there who are interested in being part of that research team to investigate Stoicism, then I’d love to hear from you. Because I think it’s at that stage where it’s got very promising results. It makes sense. And, for instance, for Stoic courses for resilience to be offered on the NHS, we need a bit more evidence than we’ve got at the moment — and that’s something I’d like to see happen. Rob Wiblin: OK, final question for you is: You’ve done a whole bunch of research into different therapeutic modes and Stoicism over the years. Is there anything you’ve learned that is particularly surprising or funny, or really stuck in your mind? Tim LeBon: Yes. We do Stoic Weeks every year and incorporate some research into that. One year we did some work on looking at what strengths were associated with Stoicism. As we said, the strengths are quite similar to the virtues — in fact, they are mini-virtues. We kind of expected a lot of strengths to be associated with Stoicism. What we found was that every strength was associated with Stoicism, including things like humour and enthusiasm. Then we looked at which one was most associated with stoicism, and it turned out to be zest, which is enthusiasm and vigour. We looked at which one increased the most after a week of Stoicism practice, and it turned out to be zest again. So you’ve got the caricature of the Stoic as stony-faced and stiff upper lip, and the idea of a zestful Stoic was not only surprising, but also, I think, a very positive image to close with. Rob Wiblin: Yeah, slightly describing yourself there, I’d say. Reasonably zestful and pretty Stoic. Tim LeBon: Thank you very much. Rob Wiblin: My guest today has been Tim LeBon. Thanks so much for coming on The 80,000 Hours Podcast, Tim. Tim LeBon: It’s been a pleasure to be here. Thank you, Rob. Rob Wiblin: If you’d like to hear more from us on mental health topics there’s also two very popular episodes you could go back and listen to: #100 – Having a successful career with depression, anxiety, and imposter syndrome #130 – Will MacAskill on balancing frugality with ambition, whether you need longtermism, and mental health under pressure There’s also a reading of an article by Luisa Rodriguez from December 2022 which you can scroll back and find: My experience with imposter syndrome — and how to (partly) overcome it All right, The 80,000 Hours Podcast is produced and edited by Keiran Harris. Audio mastering and technical editing by Simon Monsour and Ben Cordell. Full transcripts and an extensive collection of links to learn more are available on our site and put together by Katy Moore. Thanks for joining, talk to you again soon.