Anxiety Disorders - Part One

Podcast 289: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 1 of 2)

Today, David is joined by one of his first students, Dr. Stirling Moorey, for co-therapy with Anita, a woman struggling with social anxiety. You may remember Stirling from Podcast 280. Stirling was one of David's first cognitive therapy students, and they spend a month doing cotherapy tether in 1979 and again in 1980. David described the magic of their work together in his first book, Feeling Good, and today they are reunited as a therapy team again for the first time in  more than 40 years!

I, David, am super excited about working with Stirling again, and hope you enjoy our work with Anita. Rhonda, Stirling, and I are very grateful for Anita's courage and generosity in letting us share this very personal and real session with you!

Anita is a member of the Wednesday International TEAM Training group run by Rhonda and Richard Lam, LMFT.  She lives in Nairobi, Kenya, and has a Master’s Degree in Counseling. Here is how she introduces herself:

I am Anita Awuor from Nairobi, Kenya.  I have worked as a therapist for 20 years but only recently been introduced to the TEAM Model which has changed the way I work. I work with couples, individuals and families. And recently I worked with an NGO part time.  It’s an honor for me to be here to work with David, Rhonda and Stirling.

Dr. Stirling Moorey had the good fortune to be trained by two founders of Cognitive Behavioral Therapy, Dr. Aaron Beck, and our own, Dr. David Burns. Stirling and David worked together in 1979, when Stirling was in medical school in London and came to Pennsylvania for an elective with Dr. Beck. Once he arrived, Dr. Beck asked David if he would work with Stirling, and then, history was made as David created the 5-Secrets of Effective Communication after watching Stirling provide deep empathy to the patients they worked with together.

Stirling is currently a Consultant Psychiatrist in Cognitive Behavioral Therapy and was the Professional Head of Psychiatry for the So. London & Maudsley Trust from 2005-2013. He is currently the visiting senior lecturer at the Institute of Psychiatry, Psychology and Neuroscience in London. He is the co-author, with Steven Greer of The Oxford Guide to CBT for People with Cancer, and co-edited the book, The Therapeutic Relationship in CBT, published by Sage Publishing.

T = Testing

If you click here, you can take a look at Anita’s initial Brief Mood Survey, which was completed just prior to her session with Stirling and David. As you can see, her depression and anxiety scores were in the moderate to severe range, but her anger score was minimal, only 1 on a scale from 0 to 20. Her Happiness score was extremely low, and here marital satisfaction score was fairly good, but with some room for improvement, especially in the category of “resolving conflicts.

E = Empathy

You can take a look at the first of two Daily Mood Logs that Anita sent to us just prior to the session. It describes her anxiety while driving to a support group. As you can see, her suffering was intense. She also brought in a second Daily Mood Log which described her feelings after receiving a poor evaluation from one of her supervisors at work. The supervision did not involve her clinical work but some management work she was doing.

Stirling, with backup from David, did explored and summarized Anita’s feelings. She explained that

“Sadness has been a part of my life. I’m sad more often than I’m happy. Sometimes, the negative feelings are hard to live with. . . Problems in relationships often trigger my negative feelings, especially when others criticize me, and I’ve been down the last several days because of a poor evaluation I received from one of my supervisors at work. . . I don’t like criticisms or conflicts, and sometimes I tell myself that I’ll never be comfortable in groups.”

Stirling asked about Anita’s negative thoughts when criticized:

1. I’ll never be good enough.
2. What’s wrong with me?
3. It’s all my fault.

She described a sequence where her negative thoughts about the situation lead on to more general self critical thoughts like “I’ll never be comfortable in groups” and she then ruminates about her perceived shortcomings. She said, “when I have these kinds of thoughts, the feelings of sadness, anxiety and worthlessness get very high.”

David read her two Daily Mood Logs (LINK) and she described the criticisms she received from her supervisor, who suggested that Anita’s efforts had not been helpful. Anita felt hurt and angry, especially since this was the first time she’d received criticisms from her supervisor.

Anita added that when she goes into a negative spiral, everything becomes ‘huge,” and she also tells herself, “I’m a bad mom.”

Stirling asked what she does to cope when she’s in pain:

“I cry a lot. I beat myself up. And sometimes I share my feelings with my husband, but sometimes I just hold it all inside. Sometimes sharing with my husband helps, but sometimes it doesn’t.”

David asked Anita how she was feeling now, and she said that her anxiety had already gone down a lot.

To bring closure to the Empathy phase of the session, David asked Anita to grade us on Empathy and she gave us As, and Rhonda had the same idea, scoring us as A +.

I commented on the idea that Stirling's superb empathy skills were based, in part, on the "nothing technique." He systematically, skillfully, and compassionately summarized her words and acknowledged the pain they conveyed, without trying to make interpretations, and without trying to help or rescue. In other words, he gave her nothing but tremendous listening, which was exactly what she needed!

Although this sounds simple, and nearly all therapists will think, "Oh, I do that, too," in my experience, this skill is actually quite rare. it can be taught, and that's on eo the goals of our two free weekly training groups for therapists. But learning genuine and effective use of the Five Secrets of Effective communication requires tremendous humility, dedication, and hard work on the part of the therapists who hopes to learn.

End of Part 1. Next week, you will hear the exciting conclusion of the live therapy session with Anita!