Anxiety and worry « The AI-Therapy Blog

What is phobia? Spider phobia or arachnophobia

In my undergraduate studies we were asked to learn a list of phobias for an exam. Knowing obscure phobias was a fun party trick, and great for pub trivia! In clinical practice these types of phobias are all referred to as “specific phobias”. Instead of using “arachnaphobia” for the fear of spiders, it’s more often referred to as a spider phobia (sorry Holloywood!). In this blog I am going to talk a little about spider phobias.

Spider phobia

I am going to start with a personal disclosure. My first words as a child, were not “mum”, “dad”, “yes” or “no”. They were “Allt í lagi könguló”, which is Icelandic for saying “spiders are ok!”. The background is that when I was a toddler I would freak out each time a spider would run by, and my parents said those words to me so many times that they became my first! An interesting question is “was I born with an innate fear of spiders?”.

Early theorists (e.g. Seligman, 1971) would have said that I must have been bitten by a spider as a child. This is highly unlikely given the lack of big/dangerous/biting spiders in Iceland. Due to this influential theory in clinical psychology, therapists traditionally insisted that patients must have experienced at least one bad encounter with their fear-relevant stimulus (in my case a spider) in the original development of their phobia. However, it has since been observed that human beings are likely to have been born with innate fears. Menzies (my PhD supervisor) and Clarke (1995) emphasise that a goal for the treatment of phobias is to unlearn innate fears, as many are no longer relevant in a modern environment. However, it is possible that these innate fears served a purpose for the survival of the species 60,000 years ago. For example, it is conceivable that early humans who were anxious about lions and spiders while walking through certain areas in East Africa had an evolutionary advantage. In the picture below, you can see a lion hiding in the bushes, waiting for its prey to walk by?

If so, perhaps you would have lived another day!

Dangerous predators were a real risk in those times (I am sure the spiders they had to deal with were about 10 times the size of the Icelandic ones!), and a certain level of anxiety would help increase and maintain one’s guard against them. This model of innate fears became known as the non-associative model (see further, Menzies and Clarke, 1995). It can be understood as learning that has been encoded in the human genome.

Wherever people stand on the debate about the genetic basis of phobias and anxieties, it is clear that for adults with phobias, cognitive behaviour therapy is an effective treatment. A crucial ingredient is that you take small steps to expose yourself to the feared object – in my case spiders. My innate fear of spiders reduced significantly when I moved from Iceland to Australia. In Iceland there are hardly any spiders or bugs, but in Australia you have to deal with them on a daily basis. By being forced to confront my phobia, I made some progress towards decreasing my fears (although I still hate mosquitos, but that’s more of an annoyance than a fear). In the next blog I will look at the difference between spider phobia and social phobia.

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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 find it fascinating that our online psychology services have the potential to change the lives of people anywhere on the planet. No waiting list – you can simply signup and start therapy within minutes, using your own name or a pseudonym, making absolute privacy a reality!

After 7 years of development, we are finally launching our Internet treatment program to the world. Please take a look at http://www.AI-Therapy.com. Cognitive behaviour therapy is the leading treatment for social anxiety. Our service is unique.

Our service is unique in that we have have taken psychological data from major anxiety clinics, and used this data to detect common themes and patterns among those with anxiety. Next, we have used this information to write thousands of different evidence based clinical psychology treatments for social anxiety. All of these interventions have been incorporated into the system. This is how we can have an automated system, yet highly individualised at the same time. We have done our best to use simple, non-technical language that everyone understands. We have also done everything possible to make it as relevant as possible to each user.

Since the program is fully automated, it is tempting to think that it is just like a book that had been put online. However, AI-Therapy is so much more. Imagine a book that remembers you, and adapts its contents based on your thoughts and concerns. Imagine a book that allows you to hear directly the voice of the authors, who explain the principles behind all the exercises and concepts described on each page. Imagine a book that has decades of experience in treating people similar to you and giving you feedback based on that experience. You can have all of this and so much more with AI-Therapy.

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Internet CBT treatment for social phobia. What is it?

A man [woman] who does not think for himself [herself] does not think at all.
-Oscar Wilde

I added the brackets to remind you, my dear reader, that it is 2012.

Internet CBT treatment for social phobia

I have created a video to help explain Internet CBT treatment for social phobia. One goal of this treatment is finding out what type of thinking people use. The video is designed to help people become more aware of these thoughts. Thinking about thinking is the first step.

Social phobia is characterised by an inflated threat perception in social situations. Sufferers experience intense fear of negative evaluation and see amplified threats in being judged by others. This exaggerated fear response has a marked impact on their relationships with others, in both public (e.g. work) and private life (e.g relationships). Frequently people suffer from low mood and exhaustion due to the distress the problem causes. Sufferers fear, avoid, or endure with significant stress the following: conversations, meeting new people, expressing a controversial opinion or disagreement, being assertive, speaking in front of a group, being the centre of attention, eating, drinking, or making mistakes in front of others.

Our Internet CBT treatment for social phobia (http://www.AI-Therapy.com) is a professional website incorporating a computerised CBT practitioner that we have been building since 2007. CBT, or Cognitive Behaviour Therapy, is a well known treatment approach supported by several hundred controlled experimental trials. Our Internet CBT treatment for social phobia offers you a fully automated computer psychologist that tailors your treatment to the specific symptoms that you report to the system. The database it uses is derived from a wealth of psychological data gathered in major anxiety and mood clinics over the past 20 years.

Your subscription lasts for 6 months, and includes the following online treatment procedures: (1) cognitive restructuring exercises; (2) mindfulness tasks; (3) exposure exercises and behavioural experiments; (4) education about the nature of anxiety and depression; (5) quizzes to test your growing understanding of your condition and its treatment; (6) emails to motivate and remind you to access the program; (7) online assessment tools to measure your improvement; and (8) voice overs by me Fjola and Ross explaining each treatment procedure covered in the program.

AI-Therapy is an Internet-based CBT treatment for social phobia comprising 7 sections. Section 1 helps the user get in the habit of becoming aware of their thoughts and behaviours. Sections 2-6 teach strategies to address unhelpful thinking and behaviours. Section 7 is focused on relapse prevention so that the user can maintain their changes in the long run.

Try a 10 questions free social phobia symptoms test

What is therapy or psychotherapy?

I’m often asked by friends, family, and people I meet, “what is therapy or psychotherapy?” so I figured it would make a worthwhile topic for a blog.

Psychological therapy, or psychotherapy, is probably one of the more misunderstood concepts around. Its popularity is evident by the vast amount of coverage it gets in popular movies and TV. As a clinical psychologist, I often cringe when watching “therapy” scenes in pop culture. For example, I watched the last episode of the 6th season of Dexter last night, where the therapist proposes an untrue/untested/completely-bullocks theory about how Debra Morgan must be in love with her brother! Fun twist for a TV show, but this theory is horrible PR for the field of evidence based clinical psychology.

This example from Dexter provides a great illustration of why a good therapist needs to be a good scientist too. Why should someone called a “therapist” have the authority to tell people things that aren’t based on evidence? The expectation for professional standards for therapists should be no less than when you go to see your family doctor. You have the right to trust that your therapist is acting in your full interest, and acting in accordance with the latest scientific findings from clinical psychology research field. Sadly though, science isn’t trendy.

Back to the original question, what is therapy or psychotherapy?

The first few sessions of therapy involve answering many questions, and filling out some standardised assessment questionnaires. Next, the psychologist uses their clinical knowledge and experience to determine what is the problem. If it is anxiety, the therapists figures out what type of anxiety one is experiencing. There are many different types of anxiety. For example, anxiety can be social anxiety, generalised anxiety, obsessive-compulsive symptoms, panic symptoms or phobias for almost anything under the sun. Each of these diagnoses need a specialised and tailored individualised treatment. Therefore, it is highly individualised what type of treatment one can receive under the general umbrella of “anxiety” or “worry problems”. Once the therapist understands the problem and has prioritized what needs to be tackled, the actual therapy can commence.

Cognitive behaviour therapy (CBT) is the state-of-the-art therapy for many psychological problems. On average it takes 12-18 sessions, where a person meets with a therapist on a weekly basis. During this time, the therapist and the client work collaboratively on understanding the thoughts and behaviours that are contributing to everyday life problems.

This may sound straightforward, but it can be incredibly tricky to think about your own thinking, and understand your own behaviours, as well as the functions they serve. You learn to assess objectively what happens in every day life, and learn to tackle these using cognitive behaviour therapy strategies. In general, this leads to a more emotionally balanced lifestyle. The great thing about this type of therapy is that if it is done well, there are no side effects, and it continues to be effective in the long run. However, as opposed to many popular miracle cures popularised on TV and in movies, CBT takes work. However, as most people who receive the benefit from it will tell you, it is worth all the effort you put in.

Social anxiety is a persistent and chronic mental health problem¹. It is estimated that between 7%-12% of people experience social anxiety at some point in their life². This means that it impacts from four to seven million people in Britain alone!

The problem of social anxiety can come in many forms, such as extreme shyness, or worry about negative evaluation by other people. It is often persistent throughout an individual’s lifetime, and therefore determining the age of onset can be a complicated matter³. Research data on childhood social anxiety is scarce⁴ , but several authors report that onset is typical in the mid-teens or early adulthood⁵.

The vast majority of people who struggle from social anxiety never seek any treatment.⁶ It is widely established that a social phobia diagnosis is frequently missed in primary care worldwide.⁷ The shame and embarrassment that lie at the heart of social phobia are highly likely to be contributors to this phenomenon. Indeed, the embarrassment is the primary reason why socially anxious individuals do not report their symptoms to their family doctor⁸. In a study of 9,282 individuals it was evident that those with the most severe social phobia were the least likely to receive treatment⁹.

Astonishingly, once the diagnosis has been made, it can take up to 17 years for treatment to be sought.

One solution is online CBT treatment for social anxiety

Given the above problems, there is a strong need to find and facilitate ways to make it easier for socially phobic individuals to seek and receive professional help¹⁰. One of the goals of AI-Therapy is to address this problem. The core ideas were developed as part of my PhD research, but have now been extended to be an online self-help treatment for a wider audience. One goal behind this method of service is to reach those who would never make into a psychology clinic in the first place. Furthermore, it provides an option for those who, for one reason or another, are unable to see a psychologist on a regular basis. Finally, the anonymity of online therapy can be an advantage for some clients.

1) Yonker 2003

2) Furmark, 2002; Kessler et al., 2005; Ruscio et al., 2008

3) Rapee, Schniering, & Hudson, 2009.

4) Rapee et al., 2009

5) Antony & Rowa, 2008; Antony, Federici, & Stein, 2009; Hofmann et al., 2009

6) Beck & Clark, D. A., 2010.

7) Beck & Clark, D. A., 2010; Lampe, 2009.

8) Davidson, 2007

9) Ruscio et al., 2008.

10) Beck & Clark, D. A., 2010; Lampe, 2009.

Nobody sat down and decided to create the Internet

In March 1989 the blueprint for the Internet were sent by Tim Bernes-Lee to his boss at CERN. It had the humble title of: Information Management: A Proposal. The comment he got back was “Interesting, but vague”, but he was allowed to continue to pursue this Information Management System. It’s creation was motivated by Tim wanting to communicate with other researchers around the world. For this he created what we now know as the Internet. It certainly is not exclusive to nerdy researchers anymore, more accurately it takes up most of our waking lives!

The community needs better access to evidence based techniques

AI-Therapy.com came about in a bit similar manner. I was finishing my clinical psychology Internships in Sydney, Australia. However, before my last year had finished I was awarded a prestigious PhD scholarship at the University of Sydney. There was a major dilemma, do I miss out of this exciting scholarship award which was funded to respond to the need for evidence based treatments using the internet, or do I not finish my clinical psychology training/internships?

From this AI-Therapy was born.

My solution to this problem was to generate a fully automated computer psychologist which could be treating people online simultaneously with me working at the various hospital settings for my internships. It turns out, that to solve my problem of doing two things at once, I created a product which helped bridge the gap between the need for access to evidence based psychology techniques in the general community. After many years of hard work, I am pleased to announce that this service is now available to the general public under the name of AI-Therapy overcome social anxiety. You can see how it works here.

If you are interested in the original research for this computer psychology service, please refer to the following research and the associated publications

The AI-Therapy Blog

Category Archives: Anxiety and worry

Spider phobia (aka arachnophobia)

What is phobia? Spider phobia or arachnophobia

Spider phobia

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