Last night I went to see Captain Phillips (not a blog-worthy experience in itself, but the movie was very good). One of the advertisements was for the latest Google Nexus 7:
This ad has been viewed millions of times on YouTube, not including all the views on TV and in movie theaters. The fear of public speaking has been a research topic within psychology for at least two decades, and major advancements have been made. In particular, it is now known that cognitive behavior therapy (CBT) is the most successful way to decrease fear and anxiety. Furthermore, the elimination of safety behaviors is a crucial component in tackling this problem. In this advert, it looks as if one simply needs to prepare (and being Google, “preparation” is watching YouTube speeches with a Nexus tablet). Obviously, there is much more to it than this. In fact, over-preparation is a behavior that can actually maintain social anxiety in the long term. In other words, sometimes the things we do to cope with short term anxiety are the very reason why the anxiety persists in the long run.
I am not saying it is unhelpful to watch clips of great speakers – we can all learn a lot from the masters. Also, being adequately prepared is important. However, real life can be more of a struggle than it is presented in commercials, and true gains are the result of hard work, not a fancy new tablet.
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
I would like to share a very important article that was published in the New York Times a few days ago. It is called “Psychotherapy’s Image Problem”, and was written by Brandon A. Gaudiano of Brown University.
Here is a brief summary of Dr Gaudiano’s main points:
The number of people using psychotherapy alone for mental health problems is dropping, while the number of people using medication alone is increasing
Recent trials show that therapy is more effective in the long run than medication for many of the most common disorders
Why are fewer people seeking psychotherapy? The author suggest that the profession has an “image problem”. In particular:
There is no “Big Therapy” lobbying group to promote the field. On the other hand, Big Pharma has deep pockets to aggressively market their drugs
Many practitioners are not using evidence-based therapies, giving the field as a whole a bad repuation
If we do not promote treatment guidelines that are firmly supported by evidence, psychotherapy risks being sidelined in the future
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
We’ve been very busy at AI-Therapy over the past few months. In this post we will summarize some of the new developments.
Icelandic TV Appearance
I was interviewed for the evening news in Iceland a few weeks ago:
During the interview I gave a demonstration of AI-Therapy’s social anxiety treatment program, and announced our new program in development called Overcome Fertility Related Stress (see below).
Fertility Survey
I have started working on a new treatment program for people who are struggling with the emotional aspects of conception and fertility problems. I’ve created a survey, and the information I gather will be used to ensure that the program is helpful for a wide range of people:
Ross Menzies and I are developing a treatment program for people who have Obsessive Compulsive Disorder. If you would like to be kept up to date on this project, please register your interest here:
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
Quality of life is worse if you have social anxiety
Quality of life measures provide clinicians with information about their client’s “real life”. What do I mean by mean by “real life”? This includes topics like health, self-esteem, goals and values, money, work, hobbies, learning, creativity, love, friends, family, community, etc. People are asked to subjectively assess how satisfied they are with these various categories. Study after study has shown that living with an anxiety disorder can have a significant negative impact in all of these areas. It is important for effective therapy to consider the broader implications of a disorder, rather than focus purely on the specific symptoms.
The World Congress of CBT
At the 7th World Congress of CBT I attended a symposium called “Quality of Life and Anxiety Disorders”. The presenters included leading authorities in CBT, such as Lars-Göran Öst (Sweden), Lisa Liberman (Chile) Ron Rapee (Australia) and Thomas Ollendick (Virginia, USA). I was very impressed with the talks. Several of these researchers are investigating complex topics. As we all know, life is chaotic and complicated, and when we have a better understanding of the intricacies of anxiety disorders we will be be able to devise better treatments.
Quality of life and anxiety disorders at the 7th world congress of CBT: Discussant Thomas Ollendick
The cultural component of social anxiety
As a social anxiety researcher, one study that I found particularly interesting was conducted by Professor Öst of Stockholm University. He compared a group of social anxious individuals from the USA with a similar group from Sweden. He found that social anxiety interfered more with people’s real lives in America.
I asked Professor Öst to speculate on why he thought this might be the case. He hypothesized that it is likely cultural. Being an introvert is perhaps more consistent with Swedish culture. On the other hand, American culture may place a higher value on outgoing personality types. This is not to say that socially anxious individuals do not suffer in Sweden; it is simply saying that there is a cultural component to anxiety disorders that we should consider. Professor Rapee added that similar findings have been found in studies comparing Asian cultures with Western cultures.
The good news for Americans with social anxiety is that there are effective treatments, and these treatments are known to improve overall quality of life. Perhaps this why we are seeing such a strong interest from the US in seeking online treatment with AI-Therapy’s social anxiety program.
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
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:
USA
UK
Iceland
Australia
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 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
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)
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 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
I recently came across the webpage of a talented designer who has a few comics on social anxiety. Here is an example:
(Click on the comic to see the original post.)
This comic is very insightful, and beautifully illustrates two points:
People without social anxiety often fall victim to the cognitive fallacy “something that is easy and natural for me should also be easy and natural for everyone else – all they need to do is try”. These are usually well-meaning individuals, but they couldn’t be more wrong.
Overcoming social anxiety is difficult. Like learning a language, it requires learning and practicing a new set of skills. This takes time and dedicated effort. In fact, overcoming social anxiety is much more difficult than acquiring most new skills, such as an instrument or a language. This is because it involves critically evaluating and challenging core thinking and behavior patterns, which operate at both emotional and cognitive levels.
Please let me know if you’ve seen any other social anxiety-inspired art.
In other news, I’m off to Lima, Peru in a few days for the The World Congress of Behavioral and Cognitive Therapies. I will be presenting data from several projects, including the latest AI-Therapy results. Stay tuned!
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
