2014-07-24 12.44.50I’ve just come back from the British Association for Behavioral and Cognitive Psychotherapies (BABCP) conference, which was held in Birmingham last week. The conference was excellent. One of my favorite talks was by my colleague Dr Clare Mein of Oxford University. She was presenting her PhD from the University of Western Australia, where she also trained as a clinical psychologist.

Dr Mein demonstrated in series of experiments how social anxiety can affect social situations. In particular, she found that people with social anxiety interact differently during conversations. For example, think about the last time you got lost in a conversation with someone who you are not anxious around (best friend, partner, etc). You got lost in the moment, and the conversation went smoothly. However, it’s very different when you feel socially anxious, isn’t it? When we are anxious there are many thoughts going through our head unrelated to the conversation itself. These are often related to impression management. Here is an example:

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The research showed that these thoughts are one reason why people with social anxiety don’t get “lost in the moment”. Unfortunately, it also showed that the conversational partner typically notices this, making the overall experience worse for both people.

Dr Mein conducted an experiment with people who have low scores on social anxiety measures.  She asked these participants to count the number of words starting with the letter ‘T’ while having a conversation. The results showed that the when the participants were distracted by the counting they weren’t fully engaged in the conversation. Furthermore, the conversation partners felt less connected. In the same way, people with social anxiety are often focused on something else (i.e. how they present themselves), having a negative impact on the conversation.

People with social anxiety often have a collection of impression management strategies that they’ve acquired over the years. One goal of treatment, such a with a therapist or an online programs like AI-Therapy, is to identify and let go of these behaviors. This frees you to focus on the conversation. The good news is that if you successfully overcome social anxiety you’ll be able to enjoy high quality social interactions with everyone, not just your friends and family.

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, a senior research clinician at the University of Oxford, and is a co-creator of AI-Therapy, a developer of online CBT treatment programs.

Stop mental health stigma, and start seeking help
Stop mental health stigma, and start seeking help

A recent study has shown that living with an untreated mental illness lowers life expectancy. Therefore, not only do suffers get less enjoyment from their day to day life, but their lives are shorter. Why is it that people continue to suffer in silence?

Perhaps the main reason that people do not seek treatment is the stigma surrounding mental health. Sadly, this is widespread in today’s society, and there are several reasons for it. For example, we’ve all seen movies where someone commits a horrific crime, and the text at the end tells us that the person is now seeking therapy. This creates an association between anti-social behavior and therapy. This is outrageous, as the vast majority of people who seek therapy are normal, kind and caring people. Some people are genetically predisposed to having mental health problems, while others struggle with negative life experiences. In both cases, seeking help can be a life changing experience, and in neither case should it be something to be ashamed of.

I think it is time to start thinking about mental health problems in the same way as medical problems. If you had a friend or family member who was physically unwell, telling them that “you need help” would be kind and supportive advice. Why doesn’t the same hold for encouraging someone to see a psychologist?

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, a senior research clinician at the University of Oxford, and is a co-creator of AI-Therapy.com, an online CBT treatment program for overcoming social anxiety

I recently came across an article on the failure of the Alcoholics Anonymous (AA) treatment model. It makes a strong case, and is well worth a read (the full article is here).

Dealing with social anxiety with alcoholIf AA works for you that’s great, but you are in the minority.

I’ve been skeptical of AA for years now.  On one hand, I personally know several people who have successfully used the program, and I’m sincerely happy that they have found a way to deal with their alcohol problems. However, I have treated many more people in my professional practice for whom AA has simply not worked. 

I have serious objections to the way AA is run. In particular, their reluctance to publish information on success rates is unacceptable. The article claims that AA fails for up to 90%-95% of attendees. Until AA shows a willingness to become more transparent and adopt evidence-based treatments, there is little hope that the program’s efficacy will improve.

It is not always about the alcohol.

One flaw in AA’s treatment strategy is the assertion that alcohol is the root cause of all problems in an alcoholic’s life. In many cases this is not true, as alcohol is often used to cope with other issues. For example, let’s consider how social anxiety might cause someone to abuse alcohol, as I’ve come across this many times.

People usually feel more confident and have fewer inhibitions while drinking. This can be appealing for those with social anxiety, and can even appear to be effective in the short term. However, using this as coping mechanism has several disadvantages. For one thing, after the effects of alcohol have subsided many people find themselves in a cycle of rumination that increases feelings of anxiety. Furthermore, if you need to drink in order to deal with social situations, this can lead to a dependency or addiction.

Any treatment that focuses purely on abstaining from alcohol (as AA does) is bound to have limited success.

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, a senior research clinician at the University of Oxford, and is a co-creator of AI-Therapy.com, an online CBT treatment program for overcoming social anxiety

A lot has been written about the use of smartphones in social situations – it is the pet peeve of many. People often find it irritating to have a conversation (or eat a meal, watch a film, etc.) with someone who is constantly tapping away at their phone. In this blog I will look at the issue from a slightly different perspective. For those with social anxiety, smartphone use may actually be maintaining their problem.

AI therapy Woman With Smart PhoneA safety behavior is an action taken to manage one’s anxiety by exerting (perceived) control over a social situation. It is a behavior or action that is taken in order to prevent the core fear – being negatively judged by other people. Checking your smartphone is a perfect example that seems to be becoming increasingly common. People may do it to avoid something they fear: uncomfortable conversations, meeting new people, awkward silences, etc. In many cases they are worried that they won’t be able to “perform” in the social situation. In other cases, they may want to look important by being online and connected 24/7.

The problem with safety behaviors is that they tend to make the problem worse. On one hand, since it is an avoidance behavior, anxiety is maintained since it is never challenged. Sometimes uncomfortable conversations turn into interesting ones, sometimes awkward silences are followed by deep and meaningful comments, and sometimes when you meet new people you find a friend for life. Being on a smartphone can take away these opportunities. Also, if the social situation goes well despite being on a smartphone, one might wrongly attribute the positive outcome to the smartphone!

To illustrate another point, consider the following scenario:

Alice goes to a party where she doesn’t know many people. She is very anxious, and is worried that the other people at the party will not like her. She spends a lot of time sending text messages, as she hopes this will demonstrate that she is a social person with a wide group of friends.  The other people at the party make no effort to engage with Alice, as it looks to them like she has no interest in being there.

As you can see, the safety behavior (checking the phone) is the very reason why people are judging Alice negatively.

I should note that not all smartphone use in social situations is a safety behavior, as it depends on the reason why people are using their phone. There are many other reasons why someone may use their phone, such as bad habit or addiction (I will save that for another blog).

Our social anxiety treatment program can help you identify and challenge maladaptive safety behaviors. I encourage you to think about your actions, and try turning your smartphone off next time you are at a party. Not only are you less likely to be perceived as uninterested in the social situation, I guarantee you will have a richer experience, and you are a lot more likely to make a good impression on other people!

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, a senior research clinician at the University of Oxford, and is a co-creator of AI-Therapy.com, an online CBT treatment program for overcoming social anxiety

The shame and embarrassment that lie at the heart of social phobia are two of the reasons why those who struggle with social anxiety never seek treatment. In fact, studies have shown that a social anxiety diagnosis is usually missed in primary care since people are reluctant to report their symptoms to their GP. Furthermore, a 2008 study found that the more severe the social anxiety, the less likely individuals are to seek treatment. Finally, studies have shown that once a diagnosis has been made, the average length of time before initiating treatment is 17 years. Think about this for a minute.

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17 years. Think about all the minutes, seconds, hours and years wasted. Consider the time spent worrying about what you said, worried that someone is upset with you, not asking people to meet up, not catching up with old friends, tormenting yourself after social events about something you feel you said or did wrong. All of these are symptoms of social anxiety, and since there are effective treatments available, there is absolutely no reason to loose 17 years of your life. I urge you to take action today. Contact a qualified clinical psychologist, or try an online solution like AI-Therapy’s Overcome Social Anxiety.

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, a senior research clinician at the University of Oxford, and is a co-creator of AI-Therapy.com, an online CBT treatment program for overcoming social anxiety

I have been writing about social anxiety for a while now in academic publications, social media and in the media. However, it seems to receive a lot less reaction from people than other mental health issues, such as obsessive compulsive disorder or infertility stress.

I’ve been wondering why this is, and I have come to the conclusion that one reason is that most people don’t really understand social anxiety. How would they? People with social anxiety are experts at hiding their problem, and the mental anguish they experience.

I welcome everyone’s stories who have suffered from this problem. I would like to help raise awareness of the problem, and one way might be with a collection of anecdotes from people who live with this. Do you know anyone, or do you have a personal story about social anxiety that you would like to share? If you send it to me (fjola@ai-therapy.com) I’ll publish it anonymously – I understand that most people with social anxiety are afraid of being open about their problem. For those who contribute, you’ll be helping others by identifying what social anxiety is and raising awareness of this debilitating condition!

big-group-of-people-of-different

It was great to see that yesterday BBC was covering how difficult Christmas can be for those with social anxiety. However, I have to disagree with the psychologist who was quoted in the article:

Chartered clinical psychologist Dr Oliver James believes that any benefits related to CBT are temporary, and effective treatment should deal with the causes as well as the symptoms of anxiety.

“It [CBT] encourages people to tell themselves a story about their anxiety and makes no attempt at all to understand the causes,” he claims.

He is clearly not up to date with latest scientific findings about the value of CBT for treating social anxiety, since both of these arguments are flat out wrong. (1) Decades of research consistently show that gains made from CBT therapy are maintained in the long term. (2) It directly tackles the underlying causes of social anxiety by targeting the thoughts and behaviors that maintain it.

Fjola

Fjola  Helgadottir, PhD, MClinPsych, is a clinical psychologist, a senior research clinician at the University of Oxford, and is a co-creator of AI-Therapy.com, an online CBT treatment program for overcoming social anxiety

The relationship between salaries and social anxiety

It is a known fact that one area where social anxiety has a big impact on people’s lives is in the workplace. In particular, studies have found that people with social anxiety are less likely to be promoted and have, on average, lower salaries.

When was the last time you asked your boss for a raise?

Lack of assertiveness is one cause of this problem. For some people, being assertive is “too risky” since they have a strong fear of negative judgement – particularly by authority figures. For example, you might be worried about annoying or upsetting your boss, so you convince yourself that “now is not a good time to ask”. Unfortunately, the “right time” never seems to present itself.

In the past, psychologists and counselors would teach you techniques about how to present yourself. For example, common advice would be “make eye contact” and “stand tall with a straight back”. However, if you learn techniques like these without tackling the underlying social anxiety or the fear of negative evaluation, you’ll probably still struggle to gather the courage to ask for a raise.

longterm

Facing your fears (with CBT) can be a life changing experience.

One of the most effective ways to tackle anxiety is with a technique called cognitive behavior therapy (CBT). This is a long term solution, since it helps people evaluate and challenge their thoughts and behaviors, making them more likely to engage in activities they previously avoided.

In our AI-Therapy program, we use CBT to identify and target the thoughts and behaviors underlying the user’s social anxiety. Not only do our user report fewer social anxiety symptoms after completing the program, but also an increase in happiness and overall quality of life. Who knows – maybe it will give you the courage to ask for that promotion in 2014?

 

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, a senior research clinician at the University of Oxford, and is a co-creator of AI-Therapy.com, an online CBT treatment program for overcoming social anxiety