When an anxious person seeks treatment, there is a low chance that they will receive evidence-based treatment recommended by international guidelines (Powers and Deacon, 2013Stobie et al., 2007).

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:

CBT involves strategies which 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.

Sigurðardóttir, Helgadóttir, Menzies, sighvatsson & Menzies (2022)

“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

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