Last week was an interesting one, to say the least. It seems like there was non-stop stories about the havoc in the White House. One story didn’t get as much attention as the others (for obvious reasons), but it caught my eye because it made me think about cognitive behavior theory (CBT). I’m talking about Trump’s theory that the body works like a battery. He believes that people have a fixed amount of energy for their whole life, so we should avoid exercise and not overexert ourselves. To back up his theory, he points to all of his friends who exercise and need to get hip replacements and other medical procedures. Trump believes this theory, and he “feels” it is correct. Therefore, he decides to not exercise himself.

What does this have to do with CBT?

Post-event rumination is a central feature of social anxiety. This means that after a social event someone with social anxiety analyzes the interactions in detail to try figure out if they have done or said anything wrong. The problem with this approach is confirmation bias. If we try to uncover evidence for our “social errors” we will find it. This is not because something bad happened. Often we “feel” like we have said or done something that has upset someone. However, just because we feel or BELIEVE we have done this, it isn’t necessarily true. We are looking for supporting evidence after the fact, just like Trump and his exercise theory.

Evidence, evidence, evidence

What can we do to help make better decisions in life? One of the key ideas behind CBT is to become an evidence based thinker. For the exercise theory, a single google search would find scientific articles contradicting the theory. We don’t need to understand the importance of peer reviewed science to understand the many compelling arguments for cardio exercise, such as longevity, mental health etc. In some situations like this we need to trust our gut instincts less, and our brains more.

The same idea applies to looking at post-event rumination. Rumination can become a habit. One may believe it is a useful strategy to make sure they didn’t “slip up” in a given situation. However, this is not productive, and we need to work out a way to limit the time spent ruminating after social situations. We have to understand that most of the time we simply have no idea what another person is thinking. In other words, when we feel they are thinking poorly of us, this is usually without any direct evidence.  It is just a product of our own minds, and is best ignored, just like Trumps theory on exercise!

 

fdh2Fjola  Helgadottir, PhD is a registered psychologist at the Vancouver CBT Centre, who has previously 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. Twitter: @drfjola

Arguably no other notable figure in history was so fantastically wrong about nearly every important thing he had to say.   – Todd Dufresne on Sigmund Freud in a 2004 LA Times Article

Freud was strange. On one hand, he’s the most famous therapist in history, and I have to admit I was excited to visit his former clinic on vacation in Vienna last year:

Fjola at Freud Museum

 

On the other hand, his theories are at best unsupported by evidence, sometimes completely ridiculous (I’m looking at you, penis envy), and at worst harmful.

Freud invented a form of psychological treatment called psychoanalysis. One of the cornerstones of psychoanalysis is that our personalities are strongly dependent on events in our early childhood. Obviously, this is true to some degree. We are all shaped by both our genetics and personal history, and childhood experiences can be influential. However, Freud and modern evidence-based psychology differ on how we should go about dealing with our past.

Dealing with the past is a controversial and complex topic. To begin with, there are different types of negative past events. For example, being bullied as a child is quite distinct from a difficult breakup. Therefore, the specific treatment will depend on the individual and their circumstances. I will not attempt a full literature review of this active research area, but I will make two general comments.

 

1. We can’t change the past, but we can change the way we think about the past.

It is important to acknowledge the negative events of our past, but unlike psychoanalysis, we must realise that they do not determine “who we are”. We are capable of living happy lives if we learn to think in a more rational, positive way. How can we accomplish this? If you’re a regular reader of my blog you will know what I’m about to say: cognitive behaviour therapy (CBT). CBT does NOT adhere to “just get over it” attitude. Rather, the goal of CBT treatment is to identify and target the unhelpful thinking patterns in the present that are maintaining the problem. Ultimately, the aim is to get to the point where these memories no longer upset us. In a sense, CBT therapy really isn’t about the past at all.

 

2. Dwelling too much on the past is not good for our mental health. However, if not the past, what should we be thinking about? When are we happiest?

“Live in the moment” is common advice, and in this case, it seems to be right! There is some interesting research that shows we are happiest when we are absorbed in what we’re doing, not letting our minds wander. CBT also has strategies to help people accomplish this! I try to do this as much as possible, while taking the occasional break to plan my future using my nerdy excel method.

These two points have something in common: the present. Since Freud’s time, it seems we’ve learned that living in the present is the key to dealing with the past.

 

 

fdh

 

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

 

In anticipation of the upcoming “Mental Illness Awareness Week”, today I am going to discuss 5 devastating consequences of mental health problems. Unfortunately, the consequences are exacerbated by stigmas against those who suffer from mental illnesses, and stigmas against seeking treatment. I am hoping to show you that anxiety, depression, eating disorders, etc. are no less real than other “physical” problems, and deserve to be treated in a similar manner. (I put physical in quotes because, of course, mental and physical problems are deeply intertwined. However, that’s a topic for another blog).

There sometimes seems to be an underlying attitude that mental health problems are less serious than other disorders. This is an unhelpful and unsubstantiated viewpoint. Nobody asks cancer victims to “just toughen up”. However, this is often the sort of advice given to those with mental health issues. This is incredibly sad, given that we now have psychological therapies that are well grounded in scientific research. In particular, new psychological treatments go through rigorous, peer-reviewed testing, in a similar manner as new medical treatments.

Let’s consider the points below, and see what we can do to break the silence around mental health.

 

1) No-help: People who suffer from problems often do not admit to themselves or others that they need help

This is perhaps the biggest problem due to mental disorder stigmas. By seeking help one is admitting that they have a problem. Often people fear that if they are known to have a mental health issue, it will adversely impact their job or personal relationships. Therefore, seeking help can be very difficult. In fact, it has been estimated that two thirds of people with mental health problems never receive proper treatment. This leaves people alone, blaming themselves, and dealing with their problem in silence.

Taking the first step can be very difficult. This is especially true for social anxiety disorder (SAD), where a fear of being negatively evaluated by others is at the core of the problem.

Small steps are fine. Try talking to a trusted friend, family member or GP. Identify trustworthy people in your life and open up to them about your problems. Quite often, this person will already be aware (to some degree) of your mental health concerns. In fact, it may be the “elephant in the room” that everyone knows about, but no one dares speak of.

In time, after becoming more comfortable with speaking and thinking about your problem, you should aim to seek professional help. However, be careful to avoid:

 

2) Bad-help: Many people get inappropriate, non-evidence based remedies

It can take some people years to build up the courage to seek help for their mental health problem. Unfortunately, not all treatments are created equal. For example, a quick search on YouTube turns up many so called “cures” that have absolutely no scientific backing. When I say “no scientific backing”, that means, despite grand claims, that no one has ever checked to see if the treatment actually works. Mental disorder stigma makes it more difficult to force people to back up their claims. Also, it creates a market of people looking for “quick fixes”.

Non-evidence based treatments usually make problems worse. In some cases, they do nothing to help the situation, so the sufferer may resign them self to a life where nothing can be done about their problem. In other cases, the treatment itself can be actively harmful.

When seeking help for anxiety, depression, eating disorders, etc., make sure to find a trained psychology/psychiatrist/therapist who uses evidence-based techniques (such as CBT). A good therapist will take their practice seriously and have high professional standards. High quality online therapies that deliver CBT are another option, especially for those without easy access to well-trained professionals, or those who would prefer to stay anonymous when seeking help.

 

 3) Suicide: As with physical illnesses, mental illnesses can be fatal

In the most tragic of cases, suicide can be a consequence of an untreated mental health problem. The stigma associated with having a mental illness can make a bad situation even worse – to a point where people see no other way out.

If you have ever thought about suicide, it is very important to seek help immediately. Check out this link to find someone in your country that you can speak to. Otherwise, go see a doctor and ask for a referral.

 

4) Alcoholism: Drinking to cope with problems  

Many people abuse alcohol in an attempt to cope with their mental health problems. For example, people with chronic untreated social anxiety may deal with it by using alcohol and/or drugs to help them perform in social situations. Other people use alcohol or drugs as a temporary escape from depression. In all cases, this coping strategy is (A) dangerous and physically harmful, and (B) making recovery from the underlying problem more difficult.

 

5) Decrease quality of life:  Happiness, health, relationships, etc

Almost by definition, mental health problems impact the happiness of those who suffer from them. People often have a low opinion of themselves, struggle in relationships, experience frequent stress, anger, and anxiety, etc. However, there are wider ranging impacts that should also be taken into consideration. For example, untreated mental health problems are associated with a shorter life span. Furthermore, one must also consider the impact on family members and loved ones.

 

Summary

The stigma associated with mental illnesses creates an environment where people are reluctant or unable to get the help they need. Untreated mental health problems have a range of follow-on effects, such as those discussed above.

I truly hope that in my life time things will change. I hope that mental disorder stigma will become history. The field of evidence-based clinical psychology is relatively young, so perhaps it is understandable that the world hasn’t caught on yet. However, we can all do our share. One way to start is for us to change our attitudes towards mental health. We need to speak about it more openly, and only advocate evidence-based treatments, as we would with any other illnesses.

 

fdh

 

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

 

There’s definitely, definitely, definitely no logic to human behavior
-BjÖrk

I tend to agree with Björk (my fellow Icelander) — especially when it comes to “common sense” approaches to self help for improving anxiety or mood issues.

Despite having about 1000 trials supporting the efficacy of cognitive behaviour therapy (CBT) in the long term, the average Jane or Joe still has not heard about CBT. CBT has consistently outperformed medication when you look at long term benefits. What you learn through the CBT sticks with you for life! First, it addresses the root of the anxiety by determining what is keeping it going in everyday life. Next, it tackles the underlying cause using experiments and exercises. With CBT you develop strategies that you can use for the rest of your life.

One of the most common ways for individuals to deal with symptoms of anxiety and depression is to purchase self help programs (books, e-books, CD/MP3s audio series, etc.). The quality of these programs varies widely. There are some very good programs out there written by experienced and qualified professionals. Some of the best programs walk the client through the principles behind CBT.

Unfortunately, for every high-quality program, there are many more poor quality programs created by “self-help gurus”. Sometimes these gurus are well meaning people who have managed to cure their own problems, and would sincerely like to help others. Other times they are created by people simply looking for a quick buck. The problem is that some techniques for dealing with mental health issues are counter-intuitive, so without proper training, self-help authors can actually make problems worse. Let’s look at an example.

A typical title for self help books might be: Successful small talk: Learn to be open, interesting and intelligent. The purpose is to advise individuals on how to better manage their impressions on other people in social situations. If only human behavior was that simple! It would be great if we could sit down and read a book that would transform us into interesting and intelligent super-humans. Unfortunately, many of the recommended strategies (e.g. rehearse what you say in advance, make constant eye contact, etc.) can actually maintain anxiety in the long run. I mentioned these processes in my last blog, and referred to them as safety behaviors.

For social anxiety, people often believe that their safety behaviors help prevent negative evaluation in social situations. However, they actually might be preventing them from learning the truth. For example, assume that I deal with my social anxiety by only telling people about the positive aspects of my life (like many of us do on Facebook!). Perhaps I believe that this will stop them from judging me negatively. The problem is that if I never test this hypothesis, I am never comfortable being myself. What is wrong with this?

Firstly, it is unrealistic. People are people, and everyone has their ups and downs. By putting this extra pressure on myself to always look perfect, I might start avoiding social situations, reinforcing the anxiety. Social situations become extremely stressful.

Secondly, this type of safety behavior might make people judge me negatively. For example, people may feel resentful about my “perpetually success”, or suspect that I’m not telling the whole truth. Also, this maintains my social anxiety in the long run since I can never test if people approve of me for who I really am!

On the surface, common sense advice like “people don’t want to hear about your problems — focus on the positive” sounds great. However, as we’ve just seen this isn’t the case. Unfortunately, many self-help books are full of these sorts of recommendations.

There are some great self help books or programs out there. My advice is that  if you do follow a self-help program make sure that it is (1) is created by a qualified professional with training in psychology/psychiatry, (2) uses CBT to tackle the core problems, and (3) does not promote behaviors that might end up making the problem worse.

 

fdh

 

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,

 

Internet CBT treatment for social phobia. What is it?

A man [woman] who does not think for himself [herself] does not think at all.
-Oscar Wilde

I added the brackets to remind you, my dear reader, that it is 2012.

 

Internet CBT treatment for social phobia

I have created a video to help explain Internet CBT treatment for social phobia. One goal of this treatment is finding out what type of thinking people use. The video is designed to help people become more aware of these thoughts. Thinking about thinking is the first step.



Social phobia is characterised by an inflated threat perception in social situations. Sufferers experience intense fear of negative evaluation and see amplified threats in being judged by others. This exaggerated fear response has a marked impact on their relationships with others, in both public (e.g. work) and private life (e.g relationships). Frequently people suffer from low mood and exhaustion due to the distress the problem causes. Sufferers fear, avoid, or endure with significant stress the following: conversations, meeting new people, expressing a controversial opinion or disagreement, being assertive, speaking in front of a group, being the centre of attention, eating, drinking, or making mistakes in front of others.

Our Internet CBT treatment for social phobia (http://www.AI-Therapy.com) is a professional website incorporating a computerised CBT practitioner that we have been building since 2007. CBT, or Cognitive Behaviour Therapy, is a well known treatment approach supported by several hundred controlled experimental trials. Our Internet CBT treatment for social phobia offers you a fully automated computer psychologist that tailors your treatment to the specific symptoms that you report to the system. The database it uses is derived from a wealth of psychological data gathered in major anxiety and mood clinics over the past 20 years.

Your subscription lasts for 6 months, and includes the following online treatment procedures: (1) cognitive restructuring exercises; (2) mindfulness tasks; (3) exposure exercises and behavioural experiments; (4) education about the nature of anxiety and depression; (5) quizzes to test your growing understanding of your condition and its treatment; (6) emails to motivate and remind you to access the program; (7) online assessment tools to measure your improvement; and (8) voice overs by me Fjola and Ross explaining each treatment procedure covered in the program.

AI-Therapy is an Internet-based CBT treatment for social phobia comprising 7 sections. Section 1 helps the user get in the habit of becoming aware of their thoughts and behaviours. Sections 2-6 teach strategies to address unhelpful thinking and behaviours. Section 7 is focused on relapse prevention so that the user can maintain their changes in the long run.

 

Try a 10 questions free social phobia symptoms test

 

 

fdh

 

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

 

What is therapy or psychotherapy?

I’m often asked by friends, family, and people I meet, “what is therapy or psychotherapy?” so I figured it would make a worthwhile topic for a blog.

figure_in_therapy_5141

Psychological therapy, or psychotherapy, is probably one of the more misunderstood concepts around. Its popularity is evident by the vast amount of coverage it gets in popular movies and TV. As a clinical psychologist, I often cringe when watching “therapy” scenes in pop culture. For example, I watched the last episode of the 6th season of Dexter last night, where the therapist proposes an untrue/untested/completely-bullocks theory about how Debra Morgan must be in love with her brother! Fun twist for a TV show, but this theory is horrible PR for the field of evidence based clinical psychology.

This example from Dexter provides a great illustration of why a good therapist needs to be a good scientist too. Why should someone called a “therapist” have the authority to tell people things that aren’t based on evidence? The expectation for professional standards for therapists should be no less than when you go to see your family doctor. You have the right to trust that your therapist is acting in your full interest, and acting in accordance with the latest scientific findings from clinical psychology research field. Sadly though, science isn’t trendy.

 

Back to the original question, what is therapy or psychotherapy?

The first few sessions of therapy involve answering many questions, and filling out some standardised assessment questionnaires. Next, the psychologist uses their clinical knowledge and experience to determine what is the problem. If it is anxiety, the therapists figures out what type of anxiety one is experiencing. There are many different types of anxiety. For example, anxiety can be social anxiety, generalised anxiety, obsessive-compulsive symptoms, panic symptoms or phobias for almost anything under the sun. Each of these diagnoses need a specialised and tailored individualised treatment. Therefore, it is highly individualised what type of treatment one can receive under the general umbrella of “anxiety” or “worry problems”. Once the therapist understands the problem and has prioritized what needs to be tackled, the actual therapy can commence.

Cognitive behaviour therapy (CBT) is the state-of-the-art therapy for many psychological problems. On average it takes 12-18 sessions, where a person meets with a therapist on a weekly basis. During this time, the therapist and the client work collaboratively on understanding the thoughts and behaviours that are contributing to everyday life problems.

This may sound straightforward, but it can be incredibly tricky to think about your own thinking, and understand your own behaviours, as well as the functions they serve. You learn to assess objectively what happens in every day life, and learn to tackle these using cognitive behaviour therapy strategies. In general, this leads to a more emotionally balanced lifestyle. The great thing about this type of therapy is that if it is done well, there are no side effects, and it continues to be effective in the long run. However, as opposed to many popular miracle cures popularised on TV and in movies, CBT takes work. However, as most people who receive the benefit from it will tell you, it is worth all the effort you put in.

 

fdh

 

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