© Ewan Morrison
I once suffered badly from panic attacks. At the time I was walking around with dangerously low self-esteem due to seeing myself as a "failure". My inner-critic was working overtime and causing me to have panic attacks in supermarkets, and this prevented me from purchasing food to feed myself with. I would stand in front of a hundred yogurts in the dairy aisle and my thoughts would start to race - a bit like this:
"Why are there are so many flavors and types of yogurt? Should I buy no fat or low fat or full fat? Which one is better for me? Should I buy a flavor that makes me happy or go with bio-active? Will it really make me healthier or it is all a lie? Is all advertising a lie? Do we really have any free will? Are all these happy shoppers around me brainwashed? Why is everyone staring at me? Why is it so hot in here and why is the terrible music getting louder? Why am I always so alone? I'll never fit in, that's why I'm such a failure! My God, why am I even alive?"
Such panic attacks might seem like something from a Woody Allen film but they were powerful enough for me to develop palpitations, sweaty palms, dizziness and nausea and I would invariably set down my empty shopping basket and run out of whatever supermarket I was in in a state physical distress, gasping for air and recoiling from the terrifying happy smiley world in which "normal" people bought dairy products with malicious displays of indifference to my predicament. My attacks were making me ill. After the supermarket panics then came the "eating for one" panics. And the thoughts went: "I can't bear eating alone," "I must stop being so alone," "I am doomed to be alone forever". I was losing a lot of weight and energy and was heading into a dangerous spiral of ill health.

If I had gone to a psychotherapist then we would have explored the incidents in my childhood that had created this "phobia", but this process might have actually made things worse (assuring me that my abnormality was deeply grounded within my personality) and nine months of exploration into my past life certainly would not have saved me from the immediate threat of damage to my internal organs from weight loss. I went down the Cognitive Behavioural route and my CBT therapist, thankfully, dealt with the problem very practically. He got me to (1) keep a diary of my panic attacks, noting times and places (2) look for and take note of places where I did not panic (3) eat in cafes or other places that did not cause me distress (4) observe my own thoughts during a panic attack and ask myself "is any of this happening to anyone else? Or is it just a product of my mind?"

In the space of a week, I had my panic attacks under control. Seven years on, whenever I feel anxiety or a rage starting I go through the same process; I step away, I alter my heart rate through "taking time out", "I de-escalate" my thinking, and tell myself that there is no real threat anywhere around me and that my mind has just made it all up. As the Roman Era Stoic philosopher Epictetus (55-135 AD) said: "Men are disturbed not by things but by their opinions about them."

The founder of REBT, Rational Emotive Behavioral Therapy, on which CBT was based, Albert Ellis, studied the sayings of Epictetus and he founded his therapy upon Stoic wisdom and techniques. Epictetus - the crippled former Roman slave famed for his emotional constancy and calm - also recommended the carrying round of notebooks; one for your daily journal and the other for useful sayings, as he believed: "Upon all occasions, we ought to have maxims ready at hand". A useful maxim from the Enchiridion (Or Manual) of Epictetus reads:"Avoid banquets. Abstain entirely from shouts or laughter at any thing or person."

Another useful one is: "Remember that it is not he who reviles you or strikes you, who insults you, but it is your opinion about these things as being insulting. When then a man irritates you, you must know that it is your opinion which has irritated you."

Maxims I wrote during my CBT course (completely oblivious to the teachings of the Stoics) included:

"There is nothing to fear in food. I create the anxiety myself." And, "I will not allow advertisements to anger me."

This ties in nicely with Epictetus when he said, "Men are disturbed not by things but by their opinions about them." And with Seneca, when he said, "There are more things ... likely to frighten us than there are to crush us; we suffer more often in imagination than in reality."

Epictetus would have been proud of me, but he would have assured me that merely observing the self in the attempt to fight panic attacks was not enough. The Stoic way (Askesis) is to see the human mind as essentially disorganized and in need of training. All distress comes from a lack of "self-mastery" and so one is to guide oneself with maxims and then take notes on one's daily progress and failings. The Stoic Marcus Aurelius (121-180 AD), in his book of Meditations often wrote to himself the daily reminder: "see that you do not do that again". As philosopher Michel Foucault noted, the texts of the Stoics are "practical books containing specific exercises one has to read, to reread to meditate upon in order to construct a lasting matrix for one's own behavior." The Stoic Seneca (4BC-65AD) said in "On Anger". "What bad habit have you cured today? What fault have you resisted? In what respects are you better?"

This process of rigorous mental self-discipline should inevitably lead to "tranquilitas" but only by being re-enforced by changes in behavior. Anyone, after all, can have epiphanies, but then fall back into error because they have not "turned their thoughts into flesh".

To this end the Stoics had a range of behavioral techniques which unified mind and action and tested the will, thus building new neural pathways. I advocate these for a relatively peaceful, panic-free, way of surviving modern life. These techniques include:

(1) Postponing an emotion for an hour. In our stressed-out work-a-day lives we're primed, like wall street traders and social media addicts, to react at lightning speed to stimulus. We believe that a large emotional investment with what's happening right now is part of feeling truly alive. Everything is so intense and instantaneous, and being on top of things makes us feel important. But, most of the time, we're over-investing emotions, exhausting ourselves and getting caught up in interpersonal and professional dramas that are ultimately meaningless. The Stoics teach us to uncouple the event of the moment from our emotional reactions, by telling ourselves to "postpone that emotion for an hour." This practice, though hard at first to master, ultimately teaches us to be extra careful about the ways in which we respond to emotions, desires, and provocations. When we get riled, worried, stressed and panicked, a little Stoic voice appears and says, "Wait, let's come back to this emotion in one hour's time". It's a way of telling ourselves "This emotion is just a thought and not at all the thing it claims to represent."

By postponing an emotion for an hour, we pause and analyze from a distance, as Epictetus told us to, whether the thing we are worried about, is even within our control. As Epictetus said, "There is only one way to happiness and that is to cease worrying about things which are beyond the power or our will." We might, for example, be getting upset and angry about what George in Human Resources thinks about us. By postponing worrying about what George in Human Resources thinks about us for an hour, we become aware that we can't actually control the contents of George's mind, so there is little point in worrying about it. As Epictetus says, "Some things are in our control and others not. Things in our control are opinion, pursuit, desire, aversion, and, in a word, whatever are our own actions. Things not in our control are body, property, reputation, command, and, in one word, whatever are not our actions."

When you postpone a troubling emotion for an hour, a miraculous thing happens, you very rarely find it is still there when you come back to look for it. Which through time, and repetition teaches us that our immediate emotions are less important than we thought, and they don't need to control us.

(2) Epictetus' walks. "Get out of the house at early dawn and no matter whom you see or whom you hear, examine him or her and then answer as you would to a question: "is it within the providence of your control?" "What did you see? A handsome man or woman? Apply Your rule? Is it outside the field of your control, or inside? Outside. Away with it. What did you see? A man in grief over the death of a child. Apply your rule. Death lies out with your control."

The purpose of this mental process is to train the mind to not be unduly emotionally affected by external situations over which it has no control. So on your walks, you can learn that you cannot control other people's lives, the economy, or the nature of the adverts that blast in your face, or the fumes from the cars or the behavior of children in the street. You cannot change these things so you should give them no thought at all. If thoughts trouble you, say "away with it", and you walk on. This cultivates the very opposite of the anxious thought that "everything is in your face" or "everything is out to get you"

(3) Negative Visualization. This is like the opposite of "looking on the bright side". In any situation, Stoics take time to consider the worst-case scenario, e.g: Losing all your possessions; losing your partner; losing a family member; losing a sense such as your sight or your hearing. Negative visualization allows you to prepare for the worst and prevents you from falling foul of false optimism. "Say to yourself in the early morning: I shall meet today inquisitive, ungrateful, violent, treacherous, envious, uncharitable men," said Marcus Aurelius.

A variation on this is lowering one's expectations in every context, to be aware of the most probable outcomes in any situation. As Epictetus said, "when in the public baths expect to be splashed in the face by strangers."

This might seem like banal and dated advice but when you apply it to modern situations it becomes extraordinarily practical.

When at the gas station, expect to have to wait in a long line behind people who chat with the teller and waste your time, after waiting for a long time in a line to get to a pump

When on an internet date, expect that you won't have much in common and that the evening will not end in love at first sight.

When in the supermarket expect to find that an item you seek is sold out.

When in a tail-back expect-in-advance to spend half an hour going absolutely nowhere and expect to be angered.

When walking down a street that in the past has had a lot of dog shit on it, expect there to be fresh dog shit.

When in a global franchise store, expect to be treated as an anonymous consumer whose existence means nothing to the shop assistants.

By endlessly preparing with negative visualisation and context awareness for the most predictable worst-case scenarios, it is remarkable how your tendencies to rage at the indignity of it all, diminish. You will no longer experience road rage. You will no longer be depressed at the blank indifferent stares of supermarket tellers. You will no longer take log jams and dog crap as personal affronts to your existence. You will no longer rant and weep when you don't get that job you wanted or when you fail to win the lottery, or when you phone-call is placed on hold with repetitive "happy music" for the fifth time. Instead, remind yourself of the crippled Epictetus descending into the Roman baths and expecting to be splashed in the face by strangers.

In preparing ourselves in this way, again and again, we, come to realize that most of our anxiety habitually comes from an overblown sense of entitlement and self-importance; from the ego shouting "how dare you, don't you know who I am!"

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More techniques of the Ancient Roman Stoic philosophers to combat modern anxiety include:

(4) Deliberate discomfort. The Stoics put themselves through forms of deprivation while meditating on losses. They went through regular exercises, such as regularly refusing the comfort of the bed for one night, and sleeping instead on a rug on a hard floor, or fasting for three days to teach themselves that what we fear and think we cannot live without more often than not turn out to be phantasms - "This life event is not as bad as I feared it might be."

This also helped to prepare the Stoics to face physical hardships, in case they lost some, or all, of what they had; to train themselves not to desire things that are outside of their control and to remember that they could strengthen their control over how they responded emotionally to "externals". So, deliberate discomfort and the expectation of un-ease and unpleasantness strengthens the person. With training you can find yourself saying: This divorce is not so bad, I will survive it. This loss of employment, is bearable, I will get through it. This loss of a health, is temporary and I will either get better or worse, but worrying about it will not help.

(5) Contemplating death and man's insignificance in the universe. Marcus Aurelius recommended walking through graveyards and witnessing the fallen on the battlefield. "Do not act as if you were going to live ten thousand years..." he said, while Epictetus agreed, saying, "You are a little soul carrying about a corpse." Contemplating death, not every minute, but at least once a day, helps us to accept that the things that seem extremely urgent and important to us, right now, will have absolutely no relevance in a hundred years, or ten years, or even one year, and maybe not even within a week, a day or an hour. Seneca's book On the Shortness of Life reminds us that it is not the duration of a life that is important but the manner in which is it lived.This humbling check in with man's Infinitesimally small place in the universe can be an immense relief; for some at least.

(6) Seneca's one simple daily denial. Seneca advised that we perform this task: to locate one thing that the mind usually craves and then to refuse it. This could be food, sex, a pleasant distraction, causal banter or even something you were about to say to someone. "Brave men rejoice in adversity..." said Seneca. "...the Stoic sees all adversity as training." So, giving up things becomes a habit, not for the sake of health, per se, but for the sake of the challenge and the training involved. The Stoics saw the untrained mind as being rather like a puppy, running this way and that, trying to eat everything, defecating everywhere, running after every piece of passing stimulus, with no understanding of when to sleep and when to play; it cannot tell the difference between itself and the world beyond that scares it and thrills; it wears itself out and destroys the serenity of its owners.

(7) Each thing in itself in the moment. The Stoics used the same methods as Buddhists to focus on the now but unlike the Buddhists they believed every daily action could be a form of meditation. They advised that when riding a horse, you focus on the horse and not what you will do tomorrow; when cooking a meal focus on the act and not on the debts you owe; when playing with your children focus on their happiness and safety and not on your fears for their future. Being more focused makes you better at all activities and alters your brain activity and the brain's connections to the body. When you are having a full-blown panic attack, you can calm yourself, by asking yourself, "is anything threatening actually happening right now - or is it just in my mind?" as Epictetus endlessly reminded us.

A powerful way to do this is by staring out the window at trees, or the street and observing nothing much happening at all as you try to get hold of your panic attack. Focus on the outside, not on the adrenalized feeling of racing pulse and breathlessness. Focus on the process, not on the projected outcome.

Observe carefully: A bird flies by, a car passes, the wind blows a leaf. Tell yourself the mantra, "nothing much is happening. Nothing needs to happen" as you keep on observing. Repeat it as you watch nothing much happening. This focus on the banal reality then makes your panicked mind-body come out of flight-or-fight mode and you sense that there is no immediate threat. In time you come to realise that, in fact, most of the dramatic things that happen in the world, begin with over-reaction in our heads.

(8) Seneca's nightly self-monitoring. Seneca advised a period of reflection and or diary reflections before sleep: "When the light has been removed from sight and my wife, long aware of my habit, had become silent, I scan the whole of my day and retrace all my deeds and words" This looking back and weighing the day has, Seneca claims, the by-product of good sleep. "How tranquil it is, how deep and untroubled." And in the morning, the Stoic wakes up, refreshed and plans out the likely challenges to come, and through negative visualisation, the possible problems ahead.

(9) All things pass. "Time is a sort of river of passing events, and strong is its current; no sooner is a thing brought to sight than it is swept by and another takes its place, and this too will be swept away", said Marcus Aurelius. Recognising that all things pass is a useful way to cope with the anxiety caused by a sense of failure. No failure is permanent and the people who judged you will change as does the entire world they live in. "All is ephemeral, fame and the famous as well". People who are depressed or even suicidal from a catastrophic collapse in status would do well to meditate on how the ultimate goal of the Stoic life is a long lasting self-control, not the fleeting thrills of success in the eyes of others. As such, failure is a necessary training. If you don't fail, you don't learn. "The thing itself was no misfortune at all, to endure it and prevail is great good fortune."

Going back to technique 5 - another calming Stoic technique around the issues of envy and humiliation, is the thought that soon enough, the people who have humiliated you or made you jealous will be gone or dead. And so will you, and none of this aggravation that seemed so important will be recorded in the books of history.

(10) Musterbating. Our final important Neo-Stoic technique was created by Albert Ellis (1913-2017) the founder of Rational Emotive Behavior Therapy, REBT (REBT then led to CBT). I mentioned him before - Ellis was a provocative break-away therapist from Queens, New York who had a unique therapeutic method that included giving advice, provoking the patient, telling vulgar jokes and anecdotes and swearing. He based his entire practice on Epictetus, and openly revealed that "discoveries" made by REBT & CBT therapists in the 1970s, were actually rediscoveries of Ancient Roman wisdom. Ellis made a profound point about a one of the biggest stress-related problems of our time: It is what he called Musterbation. This hilarious phrase is one he used to explain the state we get into when we start thinking that X or Y MUST happen. I MUST win the lottery tonight. The Democratic Party MUST win the next election or I will die. My next tweet must be liked and shared by ten people or I am a nobody. My partner MUST tell me he loves me tomorrow or I will have to leave him, and so on. As Ellis says:
"There are three musts that hold us back: I must do well. You must treat me well. And the world must be easy."
When we create mental narratives in which we demand that the world must treat us with respect and recognition and that world events must follow our desires, we set ourselves up, as the Stoics and Ellis said, for a greatly elevated sense of failure. And this endless musterbating is self-indulgent, a form of ego masturbation. When we start creating MUST narratives and crash into disappointment, we then start "Catastrophising" and are overcome with a sense that the entire world is against us, that something is wrong with us, and that we are trapped. As Ellis says, we are more than partly responsible for the emotional states we let ourselves fall into.

"People don't just get upset. They contribute to their upsetness."

So Ellis teaches us to catch ourselves in the act of Musterbating. To stop short and tell ourselves "there I go with those damn musts again". Musts also lurk within "should" and "have to", as when people say, "you should do X or Y" or when we say, "everyone has to do X or there will be a disaster." In place of must, should and have to, we could instead use phrases like "I would prefer it if..." and "I would like it if X happens, but if it doesn't, it won't be the end of my life. I'll still have work tomorrow and a roof over my head." Could, is also useful as a replacement for should. As in "I could go for a jog and I might lose some weight" rather than "I must go for a jog because I have to lose some weight."

I was an absolute "musterbator" in my twenties and thirties; almost every second thought was a must a should or a have to. Most of these musts were to do with anxiety over success. If you go around thinking that success is due to you because of your intentions and efforts then when the world and the 6 billion people in it, fail to notice that you exist, it is quite normal in the musterbating-narrative, to feel like an abject failure. To develop that musterbating-narrative even further, the next stage is to feel that you are branded with this condition for life. So you end up trapped in a cycle in which the world must do what you want and since it doesn't, you feel trapped, impotent, unable to change any outcomes, then rejected, neglected, angry and probably self-destructive. It's a very common complaint in a world in which we are endlessly told to "believe in yourself and success will come to you." A phrase and an ideology that Albert Ellis would have, in his usual tone, called horseshit.

What I learned through Ellis and the Stoic wisdom that informed him, was that chasing "success" as we currently picture it is always going to be a disaster waiting to happen. It is a temporary blip of high status, which is only ever the result of the fleeting and biased opinions of others, opinions which are subject to massive fluctuations over time. From my own notebook, after an ego-crash following a rejection I wrote, "I gave up worrying about my status, as soon as I realized I couldn't micro-manage everyone's opinion of me."

Having practiced these ten useful Stoic processes for seven years now, I can attest to having attained a kind of calm that is so stable and steadfast, so re-assuring that it has only one downside - it really annoys people who aren't Stoics. It makes them furious, as they go about their lives of musts, and road rage and panic attacks, constantly battling their sense that they are being seen as lesser in the eyes of others. But as Epictetus taught me. "Don't be concerned with other people's impressions of you. They are dazzled and eluded by appearances. Keep your attention focused entirely on what is truly your own concern, and be clear that the opinions of others are their business and none of yours."