Social anxiety and depression often occur together, and research has shown that targeting social anxiety can lead to an overall increase in mood and happiness. In this blog we look at an example of how the two can be connected.

A thought pattern that can be a contributing factor to depression is rumination. Let’s consider the following scenario: you’ve been to an evening party, and the first thought that pops into your head the next morning is “Oh no, did I really say that? I wish I hadn’t – I may have offended someone.” You continue to dwell on the thought, and over time your feelings of anxiety amplify. Eventually, you convince yourself that it was a terrible scene, and you become angry and upset.

Rumination following social situations is a common symptom of social anxiety. The social anxiety is leading you to (a) set unrealistic expectations for yourself, and (b) over-analyze the event after the fact. By targeting social anxiety, you will be less likely to ruminate, and therefore spend less time being self-critical.

As a side note, this is consistent with the results that we are observing with our social anxiety program. In particular, there is a (statistically significant) decrease in symptoms of low mood for those who complete the program. Dealing with social anxiety can have follow-on effects that lead to a happier, more fulfilling life.

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

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Statistics for Psychologists

This is a little different than our core area (online self-help), so let me explain why we’ve created it. There are lots of statistics programs out there. However, some of them are hard for non-statisticians to use, some are expensive, and most require you to install software on your computer. We wanted something accessible, easy to use, and not loaded with options we don’t need. Given our extensive background in statistics and software, we decided to create our own solution.

These are our target audiences:

1. Academia: The online calculators provide academic researchers with tools to help them distinguish between effective and non-effective therapies. Naturally our focus is psychology, but the tools themselves will be equally useful to researchers in any field.
2. Clinicians:  Too often clinicians never give stats a second thought after they finish their degree. However, chances are that you are surrounded by interesting data in your clinic. We encourage you to run some therapy data through the program, as you may be surprised by what you find!
3. Students: Learning stats isn’t easy. What we’ve created is something between an online tutorial and an interactive calculator. One way to learn the concepts is by interacting with the tools and visualizations. Try to get a feel for how changes to the input impact the results.
4. Everyone else: Statistics is much more important in our day to day lives than most people give it credit for. In particular, it helps us make sense of the world around us. Take the plunge, and see what it’s all about!

Please get in touch and let us know if you have any feedback or feature requests. Also, help us spread the word if you know of anyone who might find this useful.

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The desire to feel in control is part of the human psyche, and has wide ranging impacts.  For example, many people who suffer from depression feel that they do not have enough control over their lives. In contrast, many people suffering from anxiety problems try too hard to control every aspect of their life. In this blog I’m going to take a quick look at some research I have been involved in.

Control and anxiety

Superstition is an example of one way we can increase our feeling of control. For example, if you knock on wood after saying something you hope doesn’t happen, the superstitious belief is that the act of knocking of wood will magically influence the outcome of a future event in the real world.  Regardless of whether or not you actually believe in magic, if you conduct this ritual enough times it can lead to a pattern of learned behavior. If the undesired event does not occur, you may feel like you have contributed to the outcome, even if it was completely outside of your control. Therefore, you get a small reward for knocking on the wood, which reinforces the behavior. In the long run, this can create the illusion that you are responsible for things you have no control over. In some cases this can help maintain a form of anxiety known as obsessive compulsive disorder.

Superstition and obsessive compulsive symptoms

As mentioned above, over time superstitious behavior can lead to people believing that they can impact the outcomes of events which they actually have no control over. As a result, some people develop a strong sense of responsibility. For example, someone may have the obsessive and intrusive thought “if  I don’t knock on wood, something bad will happen and it will all be my fault”. This thought is an example of magical thinking, since magic is needed to explain a causal relationship between knocking on wood and an unrelated future event.

Several studies have observed a correlation between magical thinking and obsessive compulsive thoughts. Given this relationship, my PhD supervisor Ross Menzies and his colleague Dr Danielle Einstein had a new idea. Would it be possible to treat obsessive compulsive disorder by targeting magical thinking? The idea is as follows: if someone truly understands that there is no way that knocking on wood will impact a future event, they may be less likely to engage in the compulsive behavior. We took a look at this idea, and our early results indicate that there is some promise to this approach.

References

Danielle A. Einstein, Ross G. Menzies, Tamsen St Clare, Juliette Drobny and Fjola Dogg Helgadottir (2011). The treatment of magical ideation in two individuals with obsessive compulsive disorder.  The Cognitive Behaviour Therapist, 4, 16-29 

Fjóla Dögg Helgadóttir, Ross G. Menzies and Danielle A. Einstein. (2012). Magical thinking and obsessive–compulsive symptoms in Australia and Iceland: A cross-cultural comparison. Journal of Obsessive-Compulsive and Related Disorders, 1. 216-219

Coming up: Paper at the World Congress of Behavioral and Cognitive Therapies WCBCT 2013, July, Peru, Lima. Title: Superstitious behaviour in Iceland during and after the global financial crisis simulates the aetiology of obsessive-compulsive disorder. More…

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

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Can you change your brain with therapy?

In short, yes.

Some people view psychological treatments as “softer” than using medication, since drugs can directly target neurochemical aspects of the brain. However, this view is unjustified, since there is mounting evidence that therapy can make very real structural changes to the brain. A great example is CBT.

Cognitive behavior therapy (CBT) is an evidence-based approach to tackling mental health problems, such as anxiety or depression. CBT has been subject to countless clinical trials, and has even been shown to be more effective than medication in some long-term studies. CBT works by targeting the thoughts and behaviours that are maintaining the problem (more information about CBT, and how it can be administered online, can be found here). For example, consider someone who has social anxiety and would like to ask their boss for a raise or promotion. This would be extremely stressful situation for them, and they would likely put it off indefinitely. CBT treatment would examine the thoughts that are leading to this avoidance, and would challenge them through a series of exercises. In much the same way that physical exercise changes the body, these mental exercises can make changes to the structure of your brain!

How does CBT change the brain?

The fact that CBT changes the brain is not a particularly new result. However, neuroscience journals tend to announce findings with headlines like “The neurobiological role of the dorsolateral prefrontal cortex in…”. The details are complex, but the general idea is understandable in surprisingly basic terms.

The brain is divided into different regions or modules, each of which is specialized to perform a certain type of task. For example, the visual cortex is the region of the brain that processes the sensory input from the eyes. There are some brain structures that deal with emotions such as stress and fear, and collectively these are sometimes known as the “emotional brain”. These are very “old” areas of the brain, in the sense that we share them with our distant ancestors. When a socially anxious person is nervous when thinking about asking for a raise, it is the emotional brain that is becoming active.

There are higher order brain structures that deal with planning, logic and reasoning. These are sometimes known as the “logical brain”. These brain areas, such as the prefrontal cortex, are “newer” in the sense that they are much larger in primates than in other species. There are two key points:

• The logical brain is able to override the emotional brain. For example, our socially anxious person can take a rational look at the situation, and realize that he or she is exaggerating the potential risks. He or she might come to the conclusion “the worst case scenario is that the boss says no – that’s not the end of the world!” This thought will help them calm down, and build the confidence to actually ask for the raise.
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• Every time the logical brain overrides the emotional brain, the logical brain “muscle” becomes stronger and stronger. In other words, through CBT training the brain actually reinforces the neural pathways, so it becomes easier and easier to deal with future stressful situations.

This is good news: by changing our thinking and behaviour using CBT, we are making positive, long term, hard coded changes to our brains!

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

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I traveled to Japan, South Korea, China, Mongolia, Philippines, Brunei, Singapore, Indonesia, Malaysia, Thailand, Cambodia, Vietnam, and Hong Kong, and it was all amazing. There is no better way to learn about people than to travel to different cultures. In fact, I think I learned more about people on that trip than during my first few years of studying psychology.

“I got scammed in Thailand” is the story that most people like to hear about.

After coming back from a big backpacking trip, people often want to hear about the tough stuff. The tricky situations, the scams, the bad food, bed bugs, etc. These usually make the best stories, so obviously you don’t give equal weight to the 95% of the trip that ran smoothly. Unfortunately, focusing on these stories can have a negative side-effect. It can fuel the fears that others have about unknown places. You should always be aware of this negative bias when you are gathering information about a place you want to visit.

Speaking to locals in other countries can give an interesting perspective on negative biases

It can be very interesting to talk to people in other countries about their impressions of where you come from. For example, few years back I traveled through a country called Turkmenistan (don’t worry if you haven’t heard of it – I hadn’t either). I took the picture below one night when we camped next to the Derweze gas crater.

Turkmenistan is both fascinating and terrifying at the same time. A quick read about the terrible human rights violation gives you an idea of what I mean. However, I had a conversation with a local girl that made an impression on me. She had been invited to study arts in Seattle, but turned it down because in her mind, the US is far too dangerous to visit.

This was an eye opener to me, as I felt much more vulnerable in Turkmenistan than I ever have in America. It was a great illustration of the idea that we often overestimate the dangers associated with things we’re unfamiliar with.

What is the lesson in this? Don’t let your fear of the unknown or familiarity biases stop you from going outside your comfort zone. Life is too short!

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

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Question: When I blush, is my face as red as I think it is?

Answer: Probably not!

During my postgraduate training at Murdoch University in Perth, Western Australia, I was lucky to be involved with a fascinating research project related to blushing and worry about blushing. The team was led by Professor Peter Drummond, one of the leading authorities in blushing research. ABC Science in Australia published a great article about the work: Fear of blushing brings blush on itself.

For the project I was involved in [1], we looked at the actual physiological changes in people who had fear of blushing, and compared this to a control group. This involved measuring changes in blood flow in subject’s faces while they performed embarrassing or stressful tasks, such as delivering a speech and listening to it afterwards.  The results demonstrated that people with a fear of blushing tended to overestimate the extent of their actual physiological change. As Professor Drummond concludes in the article above “it turned out there was very little connection between how strongly people blush and how much they thought they were blushing”.  This is good news for people who are worried about blushing, as it suggests that their faces are not as red as they think.

Social Anxiety and Blushing

Professor Drummond’s more recent work examines the relationship between social anxiety and blushing. The results show that social anxiety is one of the best predictors of blushing. Therefore, as the title of the article suggests, the fear of blushing can be a self-fulfilling prophecy. This finding is valuable as it has direct practical implications for the treatment of social anxiety. In particular, it suggests that targeting the fear of blushing (e.g. through CBT) may have wider benefits.

References:

[1] Drummond, P.D., Back, K., Harrison, J., Dogg Helgadottir, F., Lange, B., Lee, C. (2007). Blushing During Social interactions in people with fear of blushing. Behaviour Research and Therapy, 45 (7), 1601-1608. More…

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

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As you may have already noticed, we’ve given the AI-Therapy website a facelift. There are a number of improvements, including easier navigation, more content, and higher quality video.  Please take a look, and let us know what you think!

Logo

We also have a new logo, which was designed by the same person who helped us with the new website (Rob Hogg of Skinny Whippet):

Conference Travel

We’re pretty excited to be going to the World Congress of Behavioral and Cognitive Therapies (WCBCT 2013) in Lima, Peru in July this year. This conference is held every three years, in various countries around the world. It provides an opportunity for researchers and clinicians to meet and discuss the “state of the art” in CBT.

I will be giving two talks at the conference:

1. I was honoured to be invited to speak in a symposium with world’s leaders in online CBT (the other speakers are Gerhard Andersson and Per Carlbring from Sweden, Pim Cuijpers from Netherlands, and Nick Titov from Australia). The title of the symposium is The latest developments in internet-based treatments of common mental disorders. I will be speaking about some of my work at the University of Oxford, as well as the latest developments with AI-Therapy.
2. My second talk is based on work I conducted with Ross Menzies of the University of Sydney and Mark Jones of the University of Queensland. The title is Superstitious behaviour in Iceland during and after the global financial crisis simulates the aetiology of obsessive-compulsive disorder.

We’re pretty busy these days, but there are exciting times ahead!

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

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Most of this sounds like common sense advice. However, if you are a regular reader of my blog you will have noticed that all she is doing is promoting “safety behaviours“. She recommends the following:

• Breathe
• Reach out to a friend (e.g. text message or phone call)
• Find a place where you feel more comfortable, such as a corner or couch
• Remember that you can always leave without telling anyone

These are classic examples of safety behaviours. Yes, it’s true they may help you get through a particular social event, but the risk is that these behaviours are maintaining the underlying anxiety in the long run. It would be much better to target the thoughts and behaviours that are causing the anxiety in the first place (for example, using CBT).

Don’t get me wrong – I know that Amy Poehler means well, and I’m still a huge fan. However, we have to remember that there is a difference between advice that “makes sense”, and advice that has been proven effective in carefully controlled experiments. Unfortunately, just because you’re a brilliant actress, it doesn’t mean you are up to date with the latest findings in evidence based clinical psychology. Let’s make a deal Amy – you keep rolling out those episodes of Parks and Rec, and we’ll keep an eye on the psychology journals.

For those who are not regular readers of my blog, here are a few that mention safety behaviours:

• Social phobia and safety behaviours
• The problem with self help books – they can make social anxiety worse!
• Mental disorder stigma and 5 of its serious consequences
• How can I sound intelligent on a date

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

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Central to social anxiety is the perceived cost of being evaluated negatively. For example, one might think “if I don’t sound smart, they’ll never agree to a second date”. This type of conditional beliefs can lead people to go to significant lengths to avoid being judged negatively by friends, family, strangers, colleagues, potential romantic partners, etc. The actions used to prevent these undesired outcomes are what psychologists refer to as safety behaviours, which I’ve discussed previously.

One of the problems with safety behaviours is that they are rarely challenged. It’s like you spend your life on one side of a brick wall, but never get to see what it’s like on the other side (where you don’t engage in these behaviours).

Let’s return to dating. A quick Google search has a lot of “helpful” advice on how to impress other people on a date (e.g. see wikihow.com). An example is to always “spend a few seconds thinking before you speak”. In my opinion, this is an example of a safety behaviour, and it can actually be detrimental. Also, a lot of the advice reinforces the idea that a person going on a date needs to spend a lot of time preparing, instead of just being themselves. What are some possible consequences of all this preparation?

1. If the date is successful, you may attribute it to specific behaviours or preparation, rather than the true cause (e.g. they liked you!).

This will reinforce the safety behaviour, and maintain underlying anxieties in the long run. You may never learn that people actually like you the most when you are being yourself.

2. Over-rehearsed communication and presentation can be a turn off.

In other words, it might be a contributing factor to a negative outcome.

3. The preparation can be a lot of work.

In fact, people with more serious social anxiety will actually cancel social events due to all the preparation they feel is necessary before going out. This is sad, as they are missing out on many opportunities in life. Who knows what would have happened if you went for that cup of coffee (even though you were feeling tired, and unprepared?). You may have met a great friend or future partner.

CBT is a technique that can be used to tackle the thoughts and behaviours that are maintaining social anxiety. It can be used by anyone who wishes to be more relaxed in social situations. In my opinion, being relaxed and yourself is the key to a successful first date.

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

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Some people remember the exact moment when they found out Santa wasn’t real. I suppose for others it is more of a gradual realisation. Last Christmas a cousin of mine told me that I was responsible for her learning the truth. Back when we were young, we were at a family party and got into an argument about Santa’s existence. I launched a scientific expedition, and made her follow me to the basement where we saw “Santa” go into a room, and an older family friend came out! I had forgotten this, but it was a vivid memory for her. For me, I do remember my older sister spilling the beans to me the previous year.

Is believing in Santa ridiculous? Should it be stopped? My answer is probably not. Here are three reasons why:

1. Most importantly, believing in Santa is a FUN for children, and I believe it is harmless fun.

In Iceland you get a present for each of the 13 days leading up to Christmas, everyone of which is left in a shoe by one of the mischievous Yule Lads. I love seeing how excited my nieces get about the Yule Lads.

2. Children’s minds work differently than adult’s minds.

When we are very young, we are wildly creative, and we are willing to believe the impossible at the drop of a hat. This is part of normal childhood development. I feel that discovering the truth about Santa can be an important opportunity to teach children about critical thinking. As they age, kids need to learn not to believe everything they are told, and learn methods of distinguishing truth from fiction. It can even be fun. For example, when my husband was young, he and his sister collected handwriting samples from all the adults in the house, and asked Santa to leave a note. On Christmas day th
ey set up a forensic lab to compare the handwriting samples! Instead of feeling lied to and betrayed, they enjoyed the process of discovery. (You won’t be surprised to hear that they both went on to careers in science and research.)

3. The Icelandic Yule Lads give parents a perfect opportunity to apply general behaviour principles on their kids.

Kids learn that positive behaviour (e.g. such as going to bed on time) can lead to a reward (e.g. a new toy in their shoe in the morning). One of my favourite books on the topic is called the Power of Reinforcement. It points out that instead of the “carrot and stick” approach, the “carrot, carrot and more carrot” can be best. Perhaps that’s why there are 13 Santas in Iceland?

Apparently a lot of mail directed to the “North Pole” ends up in this huge box in Greenland. If a little child has gone to the effort of writing a letter to Santa, I’d be the last person to break their little heart with the truth. I think my time would be better spent asking grown adults why they believe in things that are equally improbable.

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

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