On December 31st, a childhood friend wrote on FB. “I stuck to my New Years’ resolution, I managed to not get pregnant for the first time in 6 years” to which 54 people pressed a “Like”. The emotional roller coaster and demoralization this caused me on the other side of the world was intense. It is hard to describe the emotional range I experienced. Was it jealousy? Sadness? Sense of failure? Anyhow, this lovely childhood friend posted this jokingly and this is common when fertility issues are being discussed.
Dealing with fertility-related stress is often considered “lightweight”. Yet, it is one of the most distressing experiences people go through. In fact, severe psychological distress is experienced by the majority of couples who are trying to conceive and are not successful. Over 50% experience, depression, and up to 76% suffer from anxiety during this time (Lakatos et al., 2017; Pasch et al., 2016).
In the same year, I finished my Ph.D., I got married and started my job at Oxford University as a Senior Research Clinician. I felt the most successful I have ever felt in my life! In reality, it was the start of the most miserable time in my adult life. The pain and misery of unsuccessful conception permeate into every aspect of your being. The feeling of failure is unbearable. There is a constant feeling that you are doing something wrong. You constantly interrogate yourself with questions to try to solve this puzzle “do I run too much?” (I tried stopping running which was a terrible idea), “am I losing too much weight?” (I tried bacon sandwiches for a month for breakfast, an interesting fact is that my weight stayed the same).
In my spare time when I worked at Oxford, I founded a startup. Its main product was building on my Ph.D. innovation and applying my treatment algorithms to new problems. Also, the programming was done by a professional rather than me hacking myself through PHP MySQL programming which I did for my Ph.D. program creation. In my Ph.D. I created a fully automated online CBT program for those who stutter. However, at this point in Oxford, I held 4 university degrees in psychology and had worked in Cognitive Behaviour therapy research for a decade. In my various training facilities at hospitals and research settings, I had seen how CBT could be applied to different areas. With this background, I started working on a new program using Cognitive Behaviour Therapy (CBT) to tackle fertility stress using CBT techniques. The result was Overcome Fertility Stress (OFS)
Garrett T. Taylor MPA and Diane Taylor MA at the Power of U, Inc have partnered with Elizabeth City State University (ECSU) to provide enhanced social anxiety prevention for students affected by the covid-19 pandemic. This is a particularly stressful time for young people so their goal is to prevent risky behaviors such as binge drinking and help reduce mental health stigma by targetting social anxiety.
Uplift Comprehensive Services’ mission is to ensure healthy development and improve the quality of life of individuals in economically and socially deprived areas by promoting supportive services and healthy relationships between family members, community leaders, and peers.
We are very excited about this collaboration starting in July this year!
Sarah Woodruff, CRC, LPC a clinical counselor at the Outreach program at the Michigan Technological University (MTU) has received funding from MTU to provide online mental health services to their student population. The grant will offer MTU students access to the AI-Therapy Overcome Social Anxiety program this fall.
AI-Therapy has had great experiences with site licenses in the past. It involves offering students access to the program in a standalone format. It can also be offered by busy therapists who want the student to have access to extensive evidence-based material along with therapy, while the therapist chooses to use supportive therapy. Finally, some therapists create their treatment planning around the modules in the program.
Computerized CBT programs offer a solution to these problems, given that a computer program can be guaranteed to adhere to effective evidence-based manuals.
The main problem is getting people to use self-guided programs. This is referred to as adherence.
In this study we compared 3 different ways to improve adherence to an evidence-based treatment program called Overcome Social Anxiety with online group sessions:
1) Experimental group. Psychoeducation groups (more cognitive and behavioral work)
2) Placebo group. Progressive muscle relaxation (to control for the extra attention participants were given)
3) Control condition. No group sessions are offered when using the program.
Contrary to our expectations the placebo condition (relaxation group) demonstrated improved adherence. As with so much research, our results leave us with more questions. We are speculating why this is in our discussion session in the following paragraph:
“However, to our knowledge, a link has not been drawn between PMR and increased adherence to computerized CBT programs. One possible reason for the improved adherence could be the instant reduction of state anxiety and psychological distress brought about by PMR (Vancampfort et al., 2013). In contrast, CBT involves strategies that may produce long-term improvements in anxiety and distress tolerance but may not provide a ‘quick fix’ to physical anxiety symptoms. In short, CBT takes time to achieve reductions in anxiety, whilst relaxation strategies do not. The immediate relief brought by PMR may motivate users of the program to continue with it, since they have experienced this momentary lowered anxiety level through relaxation, unlike users who did not have access to the relaxation sessions. “
At last, I would like to congratulate Signý Sigurðardóttir on her first author publication and thank all the other fantastic co-authors for being such top-notch researchers and collaborators! The article is open access which means it is free for everyone to read:
In June of this year, it will be 10 years since we launched AI-Therapy! At the time there weren’t many online programs available, and the Artificial Intelligence boom hadn’t started. People actually read blogs frequently and we wrote a lot of blogs from 2012 to 2015. Since then we have mainly published our information on our Facebook page. In fact, our last post was written in 2018 when our first Randomized Controlled Trial was published. In that study, researchers at the University Of British Columbia in Canada took our program and conducted an independent evaluation and the results were fantastic. Overcome Social Anxiety became a certified blueprint program for healthy youth development! This is a project at the University Of Colorado Boulder that maintains a registry of Evidence-Based Programs that improve the lives of youth.
Since then we have published 7 research papers, two of which are In Press, so I will write about them in my next posts. For the time being, here is an up-to-date publication list. Right before the pandemic hit, we managed to go to the last World Congress in Berlin in 2019:
Please watch this space as these are the titles coming up for our next blogs!
Overview of our latest research (7 journal articles!)
New Online Program: Overcome Fertility Stress
New Online Program: Overcome Death Anxiety
No, Bots and Artificial Intelligence does not mean the same thing in mental health care
Dr. Fjola Helgadottir, Ph.D. is the director of AI-Therapy, runs telehealth and face-to-face practice in Vancouver, BC, Canada. She is a registered psychologist in BC, Canada, and a fully licensed clinical psychologist in Iceland, prior to this she held registration in Australia and the UK as a clinical psychologist. She has 4 degrees in psychology and over the past 2 decades, Dr. Helgadottir has specialized in evidence-based treatment for complex psychological conditions. Her main areas of expertise are Social Anxiety, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, Health Anxiety, Panic Disorder, Agoraphobia, Fear of flying, and more. Dr. Helgadottir has been using Telehealth and innovating in health care since 2007. She received the Tracey Goodall Early Career Award for her innovations in online treatment. Dr. Helgadottir has also been involved in teaching cognitive behavior therapy over the years. Furthermore, she is an active clinical researcher working in collaboration with several universities around the globe. Twitter: @drfjola
You may have noticed that things have been a little quiet on this site lately. That’s because we’ve been very busy collaborating with the University of British Columbia running a Randomized Control Trial. Our work has just been published by the Journal of Medical Internet Research (Impact factor 5.1). It is open access, so you can check it out here:
This is a pretty big deal since the trial shows that AI-Therapy’s Overcome Social Anxiety has approximately triple the mean effect size of 6 stand-alone, internet-based CBT treatments for anxiety and depression (Cohen d=0.24) found in a meta-analysis!
Another amazing was that comparing AI-Therapy’s Overcome Social Anxiety to 19 therapist assisted computerized intervention, was that AI-Therapy showed comparable results. In other words, even though therapist support appears to contribute substantially to the effectiveness of computer-delivered CBT for anxiety, our findings indicated that Overcome Social Anxiety is comparably effective to therapist-assisted interventions when delivered as a stand-alone treatment.
We have known for a long time that AI-Therapy is highly effective, since the program administers pre-post data for its users. But this trial adds to its credibility, since independent researchers at the University of British Columbia tested the program in a randomized control trial. We have lots more in the works for 2018, so please keep an eye on the site! Also visit our Publication page for more information!
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!
Fjola 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