In this video I explain one of the core concepts behind social anxiety: safety behaviors. Safety behaviors maintain social anxiety, because when we engage in them we are missing opportunities to learn from our success. Therefore, we continue to feel anxious and lose confidence.

In a recent testimonial, a user of our Overcome Social Anxiety program describes how stopping safety behavior has made major changes to his life! Our program creates a personalized formulation for each user. This includes identifying safety behaviors, and learning techniques for stopping them. You can learn more about the program here.

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, who has worked in Australia and at the University of Oxford in the United Kingdom. She is AI-Therapy’s director and co-creator of AI-Therapy’s Overcome Social Anxiety program and the creator of Flourish: Living happily while trying to conceive. Twitter: @drfjola

For my PhD I created an online social anxiety treatment for people who stutter or stammer. The results were fantastic. In fact, they were so good that Ross Menzies and I wanted to make the tool available for everyone with social anxiety, and that’s how AI-Therapy was born.

AI-Therapy now has hundreds of users from all over the world, and our results (technically known as the program’s “effect size“) have been just as strong as the original PhD version. Actually, they are even more promising as they are now based on a larger population of users.

Statistics aside, it’s also important to hear people’s stories. Unfortunately, the nature of social anxiety makes it difficult for those who suffer to speak openly about the problems. Therefore, I was extremely excited to (quite randomly) come across the following article:

How cognitive behaviour therapy helped me

It was written by a user of my PhD program, and talks about the impact CBT has had on his life. I found it humbling that the program I created made such a difference to someone who has lived with social anxiety for over 70 years.

Here are a few quotes:

The programme was one of the great events of my life. It acknowledged that people who stammer often have undesirable thoughts and beliefs and I was shown how to change these. The results were immediate. The major item I picked up from the programme was the dropping of safety behaviours.

Shortly after the course finished I attended a dinner with 25 people. Normally this would involve the minimum of social conversation from me. On this occasion I made use of the techniques I had picked up and talked just about non-stop and on several occasions I was told to stop talking and eat as everyone was waiting for me to finish my meal so they could have the next course served.

Each conversation that I approach I now face with determination and courage. No longer do I stand back and rehearse what I am going to say before saying it. I have become very outspoken and have no problem at all in speaking up at meetings to add to the discussion. People I have met since completing the CBT programme have no idea that I stammer and when I tell them they are amazed by my story of how CBT changed my life.

I highly recommend you read his whole story. As I mentioned, AI-Therapy’s Overcome Social Anxiety program has been enhanced to be suitable for anyone with social anxiety. I hope it continues to change lives.

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, who has worked in Australia and at the University of Oxford in the United Kingdom. She is AI-Therapy’s director and co-creator of AI-Therapy’s Overcome Social Anxiety program and the creator of Overcome Fertility Stress. Twitter: @drfjola

Emma Watson did a wonderful speech for the UN recently, and if you haven’t seen it yet you should really check it out:

She launched a campaign called “HeForShe”, where men around the world are asked to join the gender equality agenda. The speech has gone viral (when I opened my Facebook this morning it seemed like half of my friends were raving about it). I came across some coverage of it with the headline “Her Voice Might Tremble, But Emma Watson’s Message Is Strong and Clear.” In my opinion, I found her voice to be very human and down to earth. I think her message was stronger because of this touch of tremble, which highlighted the fact that the speech wasn’t easy for her. Remember, this is a famous actress whose career is performing. She was nervous because nobody feels confident all of the time, and stepping outside of our comfort zone is when we grow.

This made me think of social anxiety and how we treat it. Cognitive behavior therapy (CBT) for social anxiety challenges people by moving them out of their comfort zones. We learn the most when we “put ourselves out there”. It is about experimenting with your thoughts and behaviors, and helping you live your life without fears.

I think a lot of social anxiety behavior in women is linked to gender equality. Sometimes we fear that by speaking our mind we will be labelled as “bossy”, whereas a man in the same situation could be called a “leader”. This is something we need to move past. For women, overcoming social anxiety can have a fantastic impact on their careers and self-confidence.

Fjola

Fjola  Helgadottir, PhD, CPsychol, is a clinical psychologist, who has trained all over the world. She has worked in Australia and at the University of Oxford in the United Kingdom. She is AI-Therapy’s director and co-creator of AI-Therapy’s Overcome Social Anxiety program.

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

 

A recent study says “yes”!

Online therapy is an active and growing area of research in clinical psychology. In fact, there was a symposium devoted to the subject at the recent World Congress of CBT in Lima, Peru (which I was honoured to be a part of – to be covered in a future blog). Perhaps the most important question that researchers are trying to answer is: “Does online work as well as face to face therapy?”

This is a difficult question to answer since there are so many hidden variables. In fact, there is no universal answer, since it depends on the particular online system being examined, and the skill level of the therapists involved in the study. A better questions is “Can online therapy work as well as face to face therapy?” In other words, are there any online systems that can match the results of live therapists for a specific problem? According to a recent publication, the answer is “yes”!

A team of researchers from the University of Zurich published the following paper:

  • Birgit Wagner, Andrea B. Horn, Andreas Maercker. Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders. July 23, 2013. (see this link for more information)

Can online therapy be as good as face to face therapy

The authors conducted a study involving 62 people with moderate depression. Half of the patients were treated using traditional CBT in-person techniques, and the other half were treated online. The authors found that at a three month follow up, the patients who were treated online had fewer symptoms of depression than the control group. In other words, the online treatment program actually performed better than the face to face therapy.

 

Advantages of online therapy

I have discussed some of the advantages of online therapy on this blog and in my publications. These include:

  • Clients can progress at their own pace
  • Clients have a complete record of their treatment, which they can revisit at any time
  • “Therapist drift” is a known phenomenon, where therapists move away from the best practices of a particular treatment over time. With online treatments, it is easier to enforce a consistent treatment, with the correct “dose” of clinical content delivered during each session.

Of course, online therapies have challenges of their own. In particular, it is more difficult to adapt the treatment towards the individual symptoms and needs of the users without therapist involvement. In fact, it is this problem of individual personalization that AI-Therapy’s social anxiety program attempts to address.

More studies are needed to fully investigate the strengths and weaknesses of online therapy. However, the study above adds to a growing body of evidence that online therapy has tremendous potential, and will play an important role in the future of mental health treatment.

 

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

 

Earlier this year I presented the Overcome Social Anxiety treatment program to my colleagues in the Department of Psychiatry at the University of Oxford. One of the questions from the audience was: How do you diagnose social anxiety in order to treat individuals? My answer: I don’t.

 

In the last blog I discussed the controversy around the new DSM-5. The goal of the DSM is to define the criteria for a formal diagnosis. In other words, it helps a practitioner determine whether or not person X has condition Y. I pointed out the shortcomings of this approach. In particular, the severity of a mental disorder is best measured using a continuous scale, rather than a binary classification.

 

A DSM diagnosis is important in a situation where a patient may be prescribed medication (recall that the DSM is published by the American Psychiatric Association). Most drugs have negative side effects, and they carry the risk of addiction. Therefore, taking medication for mild or moderate cases may not be a good idea. In this case, the DSM plays a vital role in determining who receives treatment. The DSM also plays a crucial role for clinical psychologists, as it guides the diagnosis and treatment of patients.

 

The situation for online self-help is different. For example, consider our Overcome Social Anxiety program. At the start of the program each user completes a series of standardized questionnaires (e.g. the “Fear of Negative Evaluation Scale” and the “Depression, Stress and Anxiety Scale”). The goal of this assessment is not a diagnosis. Rather, the goal is to determine where the user falls on the social anxiety spectrum prior to treatment. After the user completes the treatment program, they fill out the same questionnaires. The results are compared to the user’s pre-treatment results to see if their symptoms have improved.

 

We don’t require a diagnosis to use the program since people from along the whole social anxiety spectrum, from mild to severe, can benefit from treatment. The program uses online cognitive behavior therapy (CBT), which is known to be helpful in a wide range of cases. CBT involves revisiting thinking styles and behaviors. Unlike drugs, there are no negative side effects of CBT. Therefore, it can help everyone make better choices in their day to day life. This typically leads to an overall improvement in happiness and confidence, regardless of a DSM diagnosis.

 

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

How are social anxiety and depression related?

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.

Waking up with anxiety

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

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