Anxiety and worry « The AI-Therapy Blog

I recently came across an article on the failure of the Alcoholics Anonymous (AA) treatment model. It makes a strong case, and is well worth a read (the full article is here).

If AA works for you that’s great, but you are in the minority.

I’ve been skeptical of AA for years now. On one hand, I personally know several people who have successfully used the program, and I’m sincerely happy that they have found a way to deal with their alcohol problems. However, I have treated many more people in my professional practice for whom AA has simply not worked.

I have serious objections to the way AA is run. In particular, their reluctance to publish information on success rates is unacceptable. The article claims that AA fails for up to 90%-95% of attendees. Until AA shows a willingness to become more transparent and adopt evidence-based treatments, there is little hope that the program’s efficacy will improve.

It is not always about the alcohol.

One flaw in AA’s treatment strategy is the assertion that alcohol is the root cause of all problems in an alcoholic’s life. In many cases this is not true, as alcohol is often used to cope with other issues. For example, let’s consider how social anxiety might cause someone to abuse alcohol, as I’ve come across this many times.

People usually feel more confident and have fewer inhibitions while drinking. This can be appealing for those with social anxiety, and can even appear to be effective in the short term. However, using this as coping mechanism has several disadvantages. For one thing, after the effects of alcohol have subsided many people find themselves in a cycle of rumination that increases feelings of anxiety. Furthermore, if you need to drink in order to deal with social situations, this can lead to a dependency or addiction.

Any treatment that focuses purely on abstaining from alcohol (as AA does) is bound to have limited success.

Fjola Helgadottir, PhD, CPsychol, 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 lot has been written about the use of smartphones in social situations – it is the pet peeve of many. People often find it irritating to have a conversation (or eat a meal, watch a film, etc.) with someone who is constantly tapping away at their phone. In this blog I will look at the issue from a slightly different perspective. For those with social anxiety, smartphone use may actually be maintaining their problem.

A safety behavior is an action taken to manage one’s anxiety by exerting (perceived) control over a social situation. It is a behavior or action that is taken in order to prevent the core fear – being negatively judged by other people. Checking your smartphone is a perfect example that seems to be becoming increasingly common. People may do it to avoid something they fear: uncomfortable conversations, meeting new people, awkward silences, etc. In many cases they are worried that they won’t be able to “perform” in the social situation. In other cases, they may want to look important by being online and connected 24/7.

The problem with safety behaviors is that they tend to make the problem worse. On one hand, since it is an avoidance behavior, anxiety is maintained since it is never challenged. Sometimes uncomfortable conversations turn into interesting ones, sometimes awkward silences are followed by deep and meaningful comments, and sometimes when you meet new people you find a friend for life. Being on a smartphone can take away these opportunities. Also, if the social situation goes well despite being on a smartphone, one might wrongly attribute the positive outcome to the smartphone!

To illustrate another point, consider the following scenario:

Alice goes to a party where she doesn’t know many people. She is very anxious, and is worried that the other people at the party will not like her. She spends a lot of time sending text messages, as she hopes this will demonstrate that she is a social person with a wide group of friends. The other people at the party make no effort to engage with Alice, as it looks to them like she has no interest in being there.

As you can see, the safety behavior (checking the phone) is the very reason why people are judging Alice negatively.

I should note that not all smartphone use in social situations is a safety behavior, as it depends on the reason why people are using their phone. There are many other reasons why someone may use their phone, such as bad habit or addiction (I will save that for another blog).

Our social anxiety treatment program can help you identify and challenge maladaptive safety behaviors. I encourage you to think about your actions, and try turning your smartphone off next time you are at a party. Not only are you less likely to be perceived as uninterested in the social situation, I guarantee you will have a richer experience, and you are a lot more likely to make a good impression on other people!

The shame and embarrassment that lie at the heart of social phobia are two of the reasons why those who struggle with social anxiety never seek treatment. In fact, studies have shown that a social anxiety diagnosis is usually missed in primary care since people are reluctant to report their symptoms to their GP. Furthermore, a 2008 study found that the more severe the social anxiety, the less likely individuals are to seek treatment. Finally, studies have shown that once a diagnosis has been made, the average length of time before initiating treatment is 17 years. Think about this for a minute.

17 years. Think about all the minutes, seconds, hours and years wasted. Consider the time spent worrying about what you said, worried that someone is upset with you, not asking people to meet up, not catching up with old friends, tormenting yourself after social events about something you feel you said or did wrong. All of these are symptoms of social anxiety, and since there are effective treatments available, there is absolutely no reason to loose 17 years of your life. I urge you to take action today. Contact a qualified clinical psychologist, or try an online solution like AI-Therapy’s Overcome Social Anxiety.

I have been writing about social anxiety for a while now in academic publications, social media and in the media. However, it seems to receive a lot less reaction from people than other mental health issues, such as obsessive compulsive disorder or infertility stress.

I’ve been wondering why this is, and I have come to the conclusion that one reason is that most people don’t really understand social anxiety. How would they? People with social anxiety are experts at hiding their problem, and the mental anguish they experience.

I welcome everyone’s stories who have suffered from this problem. I would like to help raise awareness of the problem, and one way might be with a collection of anecdotes from people who live with this. Do you know anyone, or do you have a personal story about social anxiety that you would like to share? If you send it to me (fjola@ai-therapy.com) I’ll publish it anonymously – I understand that most people with social anxiety are afraid of being open about their problem. For those who contribute, you’ll be helping others by identifying what social anxiety is and raising awareness of this debilitating condition!

It was great to see that yesterday BBC was covering how difficult Christmas can be for those with social anxiety. However, I have to disagree with the psychologist who was quoted in the article:

Chartered clinical psychologist Dr Oliver James believes that any benefits related to CBT are temporary, and effective treatment should deal with the causes as well as the symptoms of anxiety.

“It [CBT] encourages people to tell themselves a story about their anxiety and makes no attempt at all to understand the causes,” he claims.

He is clearly not up to date with latest scientific findings about the value of CBT for treating social anxiety, since both of these arguments are flat out wrong. (1) Decades of research consistently show that gains made from CBT therapy are maintained in the long term. (2) It directly tackles the underlying causes of social anxiety by targeting the thoughts and behaviors that maintain it.

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

The relationship between salaries and social anxiety

It is a known fact that one area where social anxiety has a big impact on people’s lives is in the workplace. In particular, studies have found that people with social anxiety are less likely to be promoted and have, on average, lower salaries.

When was the last time you asked your boss for a raise?

Lack of assertiveness is one cause of this problem. For some people, being assertive is “too risky” since they have a strong fear of negative judgement – particularly by authority figures. For example, you might be worried about annoying or upsetting your boss, so you convince yourself that “now is not a good time to ask”. Unfortunately, the “right time” never seems to present itself.

In the past, psychologists and counselors would teach you techniques about how to present yourself. For example, common advice would be “make eye contact” and “stand tall with a straight back”. However, if you learn techniques like these without tackling the underlying social anxiety or the fear of negative evaluation, you’ll probably still struggle to gather the courage to ask for a raise.

Facing your fears (with CBT) can be a life changing experience.

One of the most effective ways to tackle anxiety is with a technique called cognitive behavior therapy (CBT). This is a long term solution, since it helps people evaluate and challenge their thoughts and behaviors, making them more likely to engage in activities they previously avoided.

In our AI-Therapy program, we use CBT to identify and target the thoughts and behaviors underlying the user’s social anxiety. Not only do our user report fewer social anxiety symptoms after completing the program, but also an increase in happiness and overall quality of life. Who knows – maybe it will give you the courage to ask for that promotion in 2014?

It seems like every time I open Facebook or LinkedIn I see some tips from celebrities or entrepreneurs how to be more confident or successful. In reality, a little talent, a lot of hard work, and some lucky breaks are the key ingredients to success. Yet, successful people have a tendency to attribute their trajectories to a handful of tricks people “must do” in order to succeed. Unfortunately, these tips aren’t always as helpful as they seem. In fact, they can even lead to safety behaviors. If social anxiety is a problem for you, it is important to learn about the role of safety behaviors, and see if you are using them to “play it safe” socially.

This blog post is the first in a series where I will give some common tips, and explain why they are actually counterproductive.

Tip 1. Pretend to be interested in other people

The self-improvement writer Dale Carnegie recommends that people pretend to be interested in what others are saying during conversation. While this may sound reasonable when we are trying to impress someone, it can actually backfire. First, the other person might sense a lack of genuine interest in the topic, and find it uncomfortable that the listener is pretending to be interested. Second, if the social interaction results in a positive response, the pretender is likely to attribute the success to their pretense of being interested, not that they were liked for who they are. Third, this sort of behavior can maintain unhelpful thoughts people have about themselves, such as “I’m so plain and boring”. Every social interaction is an opportunity for people to disconfirm these types of unhelpful thoughts. However, every time safety behaviors are used, an opportunity is missed.

Tip 2. Read over your emails at least 5 times

Many of us overemphasize the importance of wording in our emails. Whilst this may seem reasonable, it simply isn’t always helpful. In fact, some of the most successful people I have corresponded with send me emails full of spelling mistakes (probably due to auto spelling) and no formal structure. Life is too short to read emails more than a couple of times. Try sending emails without proofing them: it’s difficult at first, but then it becomes liberating. It becomes easier to respond from your phone or tablet, and can save you from thinking about the emails when you are doing something else!

In other news, I just had a peer reviewed paper on safety behaviors accepted in the Journal of Speech, Language and Hearing Research. Once it is in press, I will blog about this as well!

This week is the UK’s National Infertility Awareness Week. It is being organized by the Infertility Network UK, and runs from October 28-November 3. I’m very glad to see that awareness is growing for a problem that is rarely talked about publicly, but touches so many lives.

We are lucky to live in a time when medical advances are being made every day. Medication, operations, and IVF have enabled countless people to conceive who would not have had the opportunity just a decade ago. However, these options are not available to everyone, and the outcomes are not always successful. Being diagnosed with infertility problems typically comes with significant emotional and financial costs.

I am particularly interested in the stress, depression and anxiety that can result from fertility issues (please see my survey). A few weeks ago I discussed this topic in an interview with an Icelandic newspaper. I feel we need to be more sensitive when talking to people about their family planning. For example, the question “when are you going to have children?” is often inappropriate. It’s usually asked by well-meaning friends or family who have a genuine curiosity. However, if you take a moment to consider the reasons why someone does not have a child, you will see the list of possibilities is pretty short. It may be a decision of a personal nature, it may be due to relationship problems, or perhaps there are medical complications. In any of these cases, it’s not a good conversation to have over Thanksgiving dinner. In general, people will bring it up when and if they want to talk about it.

I encourage everyone to check out the National Infertility Awareness Week page, become involved, and think about how you approach these issues.

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Category Archives: Anxiety and worry

When are you going to have children?