AI-Therapy.com « The AI-Therapy Blog

Consider this situation – you are getting ready for a first date, and you think to yourself “how can I sound intelligent tonight?”. Many of us have thoughts like this. However, spending too much time trying to make yourself sound intelligent can actually be counter-productive. Furthermore, too much thinking about sounding intelligent may be a sign of untreated social anxiety (for more symptoms, you can take our 10 question social anxiety test).

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

Parks and Recreation by Amy Poehler (a.k.a. Leslie Knope) is a hilarious show; it has me in tears every time. I’ve been told more than once that Leslie and I share some traits in common. I take this as a compliment, as her character is a great role model. In fact, sometimes I try to look at the world as if I was viewing it through Leslie’s eyes. Why? It makes boring and mundane situations much more lively. If she can have that much fun at a city council meeting, so can I!

Seeing the world through other people’s eyes is a common technique that is sometimes used in cognitive behavioural therapy (CBT). Obviously, that’s not all there is to CBT, but it can be a very beneficial exercise. Everyone knows someone (either fictional or real) who has a quirky way of seeing the world. They often have great stories to tell, and are generally content and happy people. Can we “borrow” their way of thinking? Would it have the potential to make us happier? Yes and yes.

The CBT tip of trying to “think like someone else” might sound a little strange, but it can be very beneficial. In fact, it can improve your mood considerably. I recently spent a day trying to think like Leslie Knope, and it was great. Who says you can’t have waffles with whipped cream for breakfast and lunch!

Here is your challenge (yes, you): Pick a person (e.g. a friend or a TV character) who has a great outlook on life. This should be someone who is relaxed and generally happy. Try “borrowing” their thinking style for a day. When you find yourself in a situation that would normally make you bored, angry, anxious, shy, etc., try to think like that other person. I would love to hear how it goes. Please send me an email (fjola@ai-therapy.com), use CBT tip in the subject line of the email, and have fun!

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.

When someone is angry, quite often our immediate reaction is to tell them to calm down. However, have you ever noticed that telling someone to calm down can actually make them angrier?

In this blog, I’m going to discuss the reasons why some people get angry, and share some strategies to help prevent future outbursts.

Many of us have been in this situation:

The anger stimulus could have been many different things: an upsetting email, Microsoft Word’s AutoCorrect feature, Manchester United losing a match you had a bet on, or pictures of an ex-partner on Facebook. Whatever it was, the ancient “fight” response has been activated and blood is pumping through your body. You find yourself in what seems like a uncontrollable rage. However, the belief that anger is uncontrollable in some situations is largely a myth!

One of the most common misconceptions about anger is that it is best to “let it all out”. This comes from the faulty reasoning that pressure builds up inside of us, and screaming, kicking and shouting is necessary to release it. The truth (according to the latest scientific findings) is that screaming, kicking, shouting or acting out in other ways only makes a person’s anger problem worse in the long term! I am now going to discuss one reason why many people get angry, and provide an effective way for dealing with some types of anger.

We all react differently to frustrating and difficult situations. Many of us burst out in anger. A lot of anger outbursts happen due to our internal rules being broken. These rules can be due to moral or ethical reasoning. For example, when you hear about someone being cruel to a child. This anger may be justified, and is therefore difficult to address. However, some of our “rules” are much less clear cut. These are rules that have been created (or learned from family, friends or colleagues) about how we feel the world SHOULD work.

Consider this example: a few weeks ago I was taking a bus from the airport, and the driver was being very rude to me and everyone else. I was little upset, and found myself thinking “the driver SHOULD be more helpful to me and the other passengers”. Another passenger was also upset by the driver’s behaviour, and got in a heated argument. It actually escalated to a point where they were both yelling at each other. Almost certainly, the driver was motivated by SHOULD statements of his own. For example, “everyone SHOULD sit down so I can catch up on my schedule!”. Both parties felt violated, but was it really worth the outbursts?

One of the ideas behind cognitive behaviour therapy (CBT) is to identify and challenge or modify unhelpful thinking patterns, including these SHOULD thoughts.

Let’s look at some more examples of should statements, and consider advantages and disadvantages of believing them:

Everyone should always treat me nicely

Benefit	Cost
I will be happy when I am treated nicely.	A major disadvantage of this ‘should’ is that it is unrealistic. It is a fact that some people are rude and inconsiderate. If I think that all people should treat me nicely, I will become infuriated every single time it doesn’t happen. I will experience anger and frustration regularly. This thought is actually making me upset.

Dropping a belief like this is not an easy task. We all have a sense of justice in our head, encoded by our internal rules. However, unfortunately the world isn’t always a fair place. For example, some people are too entitled, selfish or narcissistic to care about the impact they are having on other people. Therefore, it is inevitable that we will encounter people who do not treat us nicely. In fact, we should actually EXPECT it to happen from time to time. If something happens that we are expecting, we are a lot less likely to get angry because of it, and we can learn to think of better strategies to deal with it.

I should always say “yes” to requests from others

Benefit	Cost
Immediately after I say “yes” to other people’s requests I feel relieved to get them off my back.	I will probably be taken advantage of in my personal and professional relationships. I will end up doing lots of things that I really would prefer to avoid. I will end up feeling overburdened. I will end up bitter and resentful of the demands of others.

Once again, this example shows how an internal rule can end up causing unnecessary distress. On the surface it seems reasonable, but if interpreted too strictly, it can lead to anger. For example, it may lead you to expect everyone else to always say “yes” to you, and may cause distress when this turns out not to be so.

Incidentally, SHOULD statements, and a deeper discussion about their role in your mood, are the topic of Part 5 of the AI-Therapy treatment program. The program also identifies your specific SHOULD thoughts, and formulates a CBT intervention to target them.

Back to the original question regarding anger myths and facts: how can you prevent outbursts? In the short term, try not to allow yourself to “let it loose”, as this can lead to a pattern of learned behaviour that is only supporting the anger response. It is better to step back, and try to remove yourself from the situation until the anger wave has passed. Every time you successfully stop an outburst before it happens, the better you become at it. Practice, practice, practice.

In the long term, you should take a close look at your internal rules (i.e. your SHOULD statements). It is very likely that some of these are underpinning your anger. Once you have identified your SHOULDs, CBT can be used to target them.

The world isn’t always a fair place, and it never will be. We can do our best to make it a better place, but we can’t always control the actions of others. However, you can learn to control your reactions to perceived wrongs.

Launch

Our July/August 2012 launch exceeded our expectations. We’ve had over 3500 visits so far, so thanks to everyone for checking us out and helping spread the word. We’re still actively promoting the site, so please contact us if you have any ideas about how we can reach more people. Any links, blog reviews, etc. would be great.

New free online social anxiety symptom assessment

Shortly after launch we added a free symptom test for social anxiety.

Blog

We will put out a new blog every week (give or take) on a wide range of topics. Some recent entries include:

Anger myths and facts – how to prevent future outbursts

How Excel can help you achieve goals

How to avoid the “Top 5 regrets of the dying”

The problem with self help books – they can make social anxiety worse!

Social phobia vs Spider phobia

Spider phobia (aka arachnophobia)

Future

We’ve got lots of exciting ideas in the works, so please keep an eye on the blog and come back soon!

Thank you for visiting! As always, we’d love to hear from you as our goal is to be constantly improving our site.

In February 2012 the guardian published an interesting article. A nurse asked people who were dying about their top regrets in life, and what they would do differently if they had the opportunity to live again. The top five follow, along with some of my thoughts about how to avoid these regrets:

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

How to avoid it: Figure out what you want from life. We all make choices about the type of lives we live. Listen to people in your life who can give you helpful and constructive advice, and ignore advice from family members or friends who think they know what you want.

2. I wish I hadn’t worked so hard.

How to avoid it: Personally, I find this one difficult. On one hand, we all need to earn a living, and sometimes we need to put in long hours just to make ends meet. Also, when someone is running their own business, or does charitable work for the good of others, working hard can be very satisfying. However, in many cases, people work 50+ hours a week at jobs they don’t enjoy, and their quality of life suffers. If you find you are in this situation, you should ask yourself why. Is it money? Status? The need to impress someone? Next, ask yourself if the long hours are actually helping you achieve this goal. Finally, ask yourself if you do achieve this goal, are you sure it will make you a happier person? When looked at it from this perspective, many people realise that no one is benefiting from time spent unnecessarily at work.

3. I wish I’d had the courage to express my feelings.

How to avoid it: This one is pretty straight forward, but also incredibly hard for those who have never expressed their true feelings. Even though this might be very very difficult at first, it gets easier with practice. Take small steps, and in time anyone can gain the confidence to express them self.

4. I wished I had stayed in touch with my friends

How to avoid it: This is an interesting one. Obviously, the many of the people interviewed for the article mentioned above were from a different, pre-Internet, generation. One can’t help but wonder if 40-years from now, will people at the end of their lives will still feel the same way? I suspect they will. In fact, some people today report feeling more disconnected from people in their lives than ever before. I like to call it the “Facebook effect”.

When I was growing up I used to call my friends and family on a regular basis. Email largely replaced phone calls, but they were still genuine and full of unfiltered news and gossip. However, with Facebook I’ve noticed how easy it is to let a deep and meaningful relationship be reduced to the occasional Facebook “Like”. I bet I am not alone with this – Facebook makes it too easy to have superficial connections with people. Also, as fun as it is to get countless one-line birthday wishes on my Facebook wall, I do miss the personal emails and phone calls I used to get.

Anyway, the point with this regret is to not rely on technology to keep you close to your friends. It takes a little more effort to pick up your phone, but at the end of your life I bet you’ll be glad you did.

5. I wish that I had let myself be happier.

How to avoid it: We really have to take a stock every now and then and figure out what makes us happy. This sounds obvious, but without a conscious effort, this self-reflection does not always happen. Once we know what we like, make time for it, and stop worrying about what everyone else thinks. We only have one life, let’s live it!

fdh

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.