It seems like every time I open Facebook or LinkedIn I see some tips from celebrities or entrepreneurs how to be more confident or successful. In reality, a little talent, a lot of hard work, and some lucky breaks are the key ingredients to success. Yet, successful people have a tendency to attribute their trajectories to a handful of tricks people “must do” in order to succeed. Unfortunately, these tips aren’t always as helpful as they seem. In fact, they can even lead to safety behaviorsIf social anxiety is a problem for you, it is important to learn about the role of safety behaviors, and see if you are using them to “play it safe” socially.

This blog post is the first in a series where I will give some common tips, and explain why they are actually counterproductive.

Tip 1. Pretend to be interested in other people

The self-improvement writer Dale Carnegie recommends that people pretend to be interested in what others are saying during conversation. While this may sound reasonable when we are trying to impress someone, it can actually backfire. First, the other person might sense a lack of genuine interest in the topic, and find it uncomfortable that the listener is pretending to be interested. Second, if the social interaction results in a positive response, the pretender is likely to attribute the success to their pretense of being interested, not that they were liked for who they are. Third, this sort of behavior can maintain unhelpful thoughts people have about themselves, such as “I’m so plain and boring”. Every social interaction is an opportunity for people to disconfirm these types of unhelpful thoughts. However, every time safety behaviors are used, an opportunity is missed.

Tip 2. Read over your emails at least 5 times

Many of us overemphasize the importance of wording in our emails. Whilst this may seem reasonable, it simply isn’t always helpful. In fact, some of the most successful people I have corresponded with send me emails full of spelling mistakes (probably due to auto spelling) and no formal structure. Life is too short to read emails more than a couple of times. Try sending emails without proofing them: it’s difficult at first, but then it becomes liberating. It becomes easier to respond from your phone or tablet, and can save you from thinking about the emails when you are doing something else!

smart_phone_message_10549

In other news, I just had a peer reviewed paper on safety behaviors accepted in the Journal of Speech, Language and Hearing Research. Once it is in press, I will blog about this as well!

 

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

This week is the UK’s National Infertility Awareness Week. It is being organized by the Infertility Network UK, and runs from October 28-November 3. I’m very glad to see that awareness is growing for a problem that is rarely talked about publicly, but touches so many lives.

We are lucky to live in a time when medical advances are being made every day. Medication, operations, and IVF have enabled countless people to conceive who would not have had the opportunity just a decade ago. However, these options are not available to everyone, and the outcomes are not always successful. Being diagnosed with infertility problems typically comes with significant emotional and financial costs.

I am particularly interested in the stress, depression and anxiety that can result from fertility issues (please see my survey). A few weeks ago I discussed this topic in an interview with an Icelandic newspaper. I feel we need to be more sensitive when talking to people about their family planning. For example, the question “when are you going to have children?” is often inappropriate. It’s usually asked by well-meaning friends or family who have a genuine curiosity. However, if you take a moment to consider the reasons why someone does not have a child, you will see the list of possibilities is pretty short. It may be a decision of a personal nature, it may be due to relationship problems, or perhaps there are medical complications. In any of these cases, it’s not a good conversation to have over Thanksgiving dinner. In general, people will bring it up when and if they want to talk about it.

I encourage everyone to check out the National Infertility Awareness Week page, become involved, and think about how you approach these issues.

Last night I went to see Captain Phillips (not a blog-worthy experience in itself, but the movie was very good). One of the advertisements was for the latest Google Nexus 7:

This ad has been viewed millions of times on YouTube, not including all the views on TV and in movie theaters. The fear of public speaking has been a research topic within psychology for at least two decades,  and major advancements have been made. In particular, it is now known that cognitive behavior therapy (CBT) is the most successful way to decrease fear and anxiety. Furthermore, the elimination of safety behaviors is a crucial component in tackling this problem. In this advert, it looks as if one simply needs to prepare (and being Google, “preparation” is watching YouTube speeches with a Nexus tablet). Obviously, there is much more to it than this. In fact, over-preparation is a behavior that can actually maintain social anxiety in the long term. In other words, sometimes the things we do to cope with short term anxiety are the very reason why the anxiety persists in the long run.

I am not saying it is unhelpful to watch clips of great speakers – we can all learn a lot from the masters. Also, being adequately prepared is important. However, real life can be more of a struggle than it is presented in commercials, and true gains are the result of hard work, not a fancy new tablet.

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

I would like to share a very important article that was published in the New York Times a few days ago. It is called “Psychotherapy’s Image Problem”, and was written by Brandon A. Gaudiano of Brown University.

big pharma vs small therapy

Here is a brief summary of Dr Gaudiano’s main points:

  • The number of people using psychotherapy alone for mental health problems is dropping, while the number of people using medication alone is increasing
  • Recent trials show that therapy is more effective in the long run than medication for many of the most common disorders
  • Why are fewer people seeking psychotherapy? The author suggest that the profession has an “image problem”. In particular:
    1. There is no “Big Therapy” lobbying group to promote the field. On the other hand, Big Pharma has deep pockets to aggressively market their drugs
    2. Many practitioners are not using evidence-based therapies, giving the field as a whole a bad repuation
  • If we do not promote treatment guidelines that are firmly supported by evidence, psychotherapy risks being sidelined in the future

I highly recommend reading the whole article:

http://www.nytimes.com/2013/09/30/opinion/psychotherapys-image-problem.html

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

We’ve been very busy at AI-Therapy over the past few months. In this post we will summarize some of the new developments.
 

Icelandic TV Appearance

I was interviewed for the evening news in Iceland a few weeks ago:

Fjola on the Icelandic news

 

During the interview I gave a demonstration of AI-Therapy’s social anxiety treatment program, and announced our new program in development called Overcome Fertility Related Stress (see below).

 

Fertility Survey

I have started working on a new treatment program for people who are struggling with the emotional aspects of conception and fertility problems. I’ve created a survey, and the information I gather will be used to ensure that the program is helpful for a wide range of people:

http://www.ai-therapy.com/treatments/fertility/

Those who participate in the survey will be given the opportunity to be beta testers for the program when it is ready.

 

AI-Therapy Site License for Clinics, Therapists and Other Organizations

Site licenses are now available for our social anxiety treatment program. More information can be found here:

http://www.ai-therapy.com/therapist-and-clinic-site-license

 

Overcome OCD

Ross Menzies and I are developing a treatment program for people who have Obsessive Compulsive Disorder. If you would like to be kept up to date on this project, please register your interest here:

http://www.ai-therapy.com/treatments/ocd/

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

Quality of life is worse if you have social anxiety

Quality of life measures provide clinicians with information about their client’s “real life”. What do I mean by mean by “real life”? This includes topics like health, self-esteem, goals and values, money, work, hobbies, learning, creativity, love, friends, family, community, etc. People are asked to subjectively assess how satisfied they are with these various categories. Study after study has shown that living with an anxiety disorder can have a significant negative impact in all of these areas. It is important for effective therapy to consider the broader implications of a disorder, rather than focus purely on the specific symptoms.
 

The World Congress of CBT

At the 7th World Congress of CBT I attended a symposium called “Quality of Life and Anxiety Disorders”. The presenters included leading authorities in CBT, such as Lars-Göran Öst (Sweden), Lisa Liberman (Chile) Ron Rapee (Australia) and Thomas Ollendick (Virginia, USA). I was very impressed with the talks. Several of these researchers are investigating complex topics. As we all know, life is chaotic and complicated, and when we have a better understanding of the intricacies of anxiety disorders we will be be able to devise better treatments.

Quality of life and anxiety disorders at the 7th world congress of CBT: Discussant Thomas Ollendick
Quality of life and anxiety disorders at the 7th world congress of CBT: Discussant Thomas Ollendick

The cultural component of social anxiety

As a social anxiety researcher, one study that I found particularly interesting was conducted by Professor Öst of Stockholm University. He compared a group of social anxious individuals from the USA with a similar group from Sweden. He found that social anxiety interfered more with people’s real lives in America.

I asked Professor Öst to speculate on why he thought this might be the case. He hypothesized that it is likely cultural. Being an introvert is perhaps more consistent with Swedish culture. On the other hand, American culture may place a higher value on outgoing personality types. This is not to say that socially anxious individuals do not suffer in Sweden; it is simply saying that there is a cultural component to anxiety disorders that we should consider. Professor Rapee added that similar findings have been found in studies comparing Asian cultures with Western cultures.

The good news for Americans with social anxiety is that there are effective treatments, and these treatments are known to improve overall quality of life. Perhaps this why we are seeing such a strong interest from the US in seeking online treatment with AI-Therapy’s social anxiety program.

 

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

 

Last month I attended the 7th World Congress for CBT in Lima, Peru. Conferences are a great way to get up to speed on the latest developments in a field, and this conference was no exception. Overall, the presentations made me very optimistic about the future of online therapy. There is a lot of exciting and encouraging research being conducted.

As part of a symposium on internet-based treatment, I presented some of the latest results from AI-Therapy’s Overcome Social Anxiety program:

Dr Fjola Helgadottir presenting AI-Therapy overcoming social anxiety at the CBT World Congress 2013

Investigation into real world treatment data

My presentation was somewhat unusual for an academic conference in that it was based on real world data. Typically, talks are based on carefully controlled trials. There is an important reason for this – one goal of a trial is to make the results reproducible by other researchers. This is a key aspect of scientific research. However, there is an important question that is often ignored: will the results translate into the real world? The real world is chaotic, users are not screened, users are not monitored, there is less control over the equipment used, etc. In the past it has been found that treatments that work well in a laboratory environment cease to have the same impact when they are released to the general population. One goal of my talk was to present data from a commercially available treatment program, and contrast this with the latest results from academic systems.

 

Visitors to the AI-Therapy website

Before continuing, I should mention that all AI-Therapy users are anonymous, and their results are kept strictly confidential. The only data I presented are aggregated, showing average scores across groups of users.

As can be seen in the slide above, we have had almost 20,000 unique visitors to the website since our launch about a year ago. The top 5 countries for visitors are:

  1. USA
  2. UK
  3. Iceland
  4. Australia
  5. Canada

These results are roughly what I would expect. The US is our largest market, but a significant margin. The reason Iceland has made the top 3 is due to some media coverage we have received there.

 

Effective social anxiety treatment

In order to assess the efficacy of the Overcome Social Anxiety program, I determined its pre-post effect size. When using the program, users fill out a series of questionnaires before starting, and the same questionnaires after completion. The effect size is a standardized measures of the reduction in symptoms over this period (see this page for information about effect sizes, and effect size calculators).

The effect size for the first 19 people who completed all sections of the program was 1.7. An effect size of 0.2 is considered small, an effect size of 0.5 is considered medium, and effect size of 0.8 is considered large. Therefore, an effect size of 1.7 is very large. (It is important to note that this value has been calculated based on people who completed the whole program, and does not include people who started the program, but did not reach the end. We intend to write up a more detailed analysis, and release it as a white paper on this site. Please watch this space.) The primary conclusion is that online treatment programs for social anxiety can be an effective treatment strategy for real world patients.

I am already looking forward to the 8th CBT World Congress, which will be held in Melbourne Australia in 2016. I look forward to seeing the advances that will be made in the online therapy field over the next  three years!

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