The Apprenticeship Model

Podcast 290: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 2 of 2)

Last week, you heard the first part of this live therapy session with Anita, a woman struggling with severe social anxiety. David and Dr. Stirling Moorey, from London, are co-therapists. Last week included the T = Testing and E = Empathy portions of the session. Today you will hear the A = Assessment of Resistance, M = Methods, along with end of session Testing and follow-up.

A = Assessment of Resistance

David asked Anita if she was ready to roll up her sleeves and get to work, or if she needed more time to talk and be listened to and supported.

Because she was eager to get to work, David asked the “Miracle Cure Question:” He said, “What would happen in today’s session if it went really great and knocked your socks off?

She said that her negative feelings and self-critical thoughts would be greatly diminished.

David asked the Magic Button Question, and she said she’d press it for sure!

David said he had no Magic Button, but did have some powerful techniques that could be super helpful, but was reluctant to use them. Anita was puzzled, and this led to Positive Reframing. He encouraged Anita to ask the three questions about each Negative Thought and feeling on her Daily Mood Logs:

1. Why might this thought or feeling be perfectly appropriate, given your circumstances?
2. What are some advantages, or benefits, of this negative thought or feeling?
3. What does this negative thought or feeling show about your core values that’s positive, beautiful, or even awesome?

Although puzzling at first, Anita soon got into the swing of it and came up with the following list of Positives.

1. If I tell myself “I have nothing to say” in a group, I’ll listen more and learn more.
2. I won’t risk speaking and making a fool of myself. So my social anxiety is really a source of self-protection, or even a form of self-love.
3. My self-criticisms show I have high standards.
4. My high standards motivate me to work hard and do my best.
5. My self-doubt shows that I’m humble.
6. My concerns about being judged show that I care for the people in the group and want to have positive relationships with them.
7. Shows I’m not pushy, dominating, or arrogant.
8. When I tell myself that “They are all better than me,” it shows that I have room to learn from all the people who are ahead of me.
9. This shows I want to grow and do better.
10. This shows I’m honest and realistic about my limits and flaws.
11. This shows I’m accountable.
12. This gives me “vicarious joy” in the accomplishments of others, a Buddhist concept.
13. This thought shows that I can appreciate the gifts of others, which is a gift to them.
14. When I tell myself, “I wasted a year,” it shows that I value hard work, learning, and dong a good job.
15. It shows that I value what other people think, and take their criticisms seriously.
16. It shows that I want to be seen for who I am!

David pointed out that there were many positives on the list, and if we had time many more could be added, but asked Anita if the positives were:

• Real?
• Important?
• Powerful?

She gave enthusiastic “yes” answers to all three questions, and then david asked the Pivot Question: Why in the world would you want to press that Magic button, because if you do all these positives will go down the drain, right along with you negative thoughts and feelings

Anita suddenly didn’t want to press the Magic Button, but agree to use the Magic Dial and lower her goals for each negative feeling, which you can see if you click here.

This concluded this part of the session, which brought us to the M of TEAM.

M = Methods

During the Methods portion of the session, David and Stirling used a number of techniques, including:

• Identify the Distortions
• Explain the Distortions
• Straightforward Technique
• Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique)

And more, using frequent role reversal until she got to “huge” wins, which didn’t take long. Stirling also asked gave Anita how she might test if her fears about the way others saw her were accurate, and they devised some homework to do in the Wednesday training group to find out if other group members had experienced similar doubts about their abilities as therapists. This would involve using:

• Self-Disclosure -
• Survey Technique
• “I stubbornly refused” Technique

You can see her final Daily Mood Log if you click here (LINK).

We also jumped in and tried to work with Anita’s conflict with her supervisor, but ran out of time and might pick up that thread again in a future session if she is interested.

I might add that both David and Stirling also used Self-Disclosure and Story-Telling during the session, as well as some spontaneous humor, which can also be viewed as a valuable treatment method, but one that is hard to explain or teach.

You can see Anita's final Daily Mood Log with the outcomes of all of her negative feelings. As you can see, she exceeded her goals in every category, which is not unusual, and was feeling pretty terrific!

She had the homework assignment to listen to the recording of the session and complete her DML, so you will only see a couple of the Positive Thoughts listed.

Final T = Testing

You can see Anita's final BMS here, and her  Evaluation of therapy Session here  As you can see, there were dramatic reductions in depression and anxiety, but only a modest boost in happiness. It would be interesting to see if the happiness goes up further after her "behavioral experiment" at Wednesday's tuesday group. Her scores on the Empathy and Helpfulness scales were perfect.

Follow-up

This is the email we received from Anita three days later, right after her "behavioral experiment" in Rhonda's Wednesday TEAM-CBT training group::

Hi Stirling, Rhonda, and David,

I did the survey question in Rhonda’s Wednesday training group. Here’s what I said:

“I am so nervous right now. I sometimes feel like I do not have much to say and so I stay silent in the group. I get anxious and think you all are so far ahead of me in your skills, so I miss out on sharing. I was wondering if any of you sometimes feel the same way?”

So many hands shot, so many affirmed my question and thanked me for asking because they get anxious too. I was a little overwhelmed. Loved the experience!

Rhonda I hope I did not take too much time.

 Anita

Rhonda, Stirling, Anita, and David