depression « The AI-Therapy Blog

On December 31st, a childhood friend wrote on FB. “I stuck to my New Years’ resolution, I managed to not get pregnant for the first time in 6 years” to which 54 people pressed a “Like”. The emotional roller coaster and demoralization this caused me on the other side of the world was intense. It is hard to describe the emotional range I experienced. Was it jealousy? Sadness? Sense of failure? Anyhow, this lovely childhood friend posted this jokingly and this is common when fertility issues are being discussed.

Dealing with fertility-related stress is often considered “lightweight”. Yet, it is one of the most distressing experiences people go through. In fact, severe psychological distress is experienced by the majority of couples who are trying to conceive and are not successful. Over 50% experience, depression, and up to 76% suffer from anxiety during this time (Lakatos et al., 2017; Pasch et al., 2016).

In the same year, I finished my Ph.D., I got married and started my job at Oxford University as a Senior Research Clinician. I felt the most successful I have ever felt in my life! In reality, it was the start of the most miserable time in my adult life. The pain and misery of unsuccessful conception permeate into every aspect of your being. The feeling of failure is unbearable. There is a constant feeling that you are doing something wrong. You constantly interrogate yourself with questions to try to solve this puzzle “do I run too much?” (I tried stopping running which was a terrible idea), “am I losing too much weight?” (I tried bacon sandwiches for a month for breakfast, an interesting fact is that my weight stayed the same).

In my spare time when I worked at Oxford, I founded a startup. Its main product was building on my Ph.D. innovation and applying my treatment algorithms to new problems. Also, the programming was done by a professional rather than me hacking myself through PHP MySQL programming which I did for my Ph.D. program creation. In my Ph.D. I created a fully automated online CBT program for those who stutter. However, at this point in Oxford, I held 4 university degrees in psychology and had worked in Cognitive Behaviour therapy research for a decade. In my various training facilities at hospitals and research settings, I had seen how CBT could be applied to different areas. With this background, I started working on a new program using Cognitive Behaviour Therapy (CBT) to tackle fertility stress using CBT techniques. The result was Overcome Fertility Stress (OFS)

In 2019, I was in Iceland and the University of Reykjavik had its “Research Marketplace”. This is where institutions present the research to Masters students in clinical psychology. Rakel Rut Björnsdóttir applied to do a feasibility study on Overcome Fertility Stress as her project. And we finally got published the following article, with the co-supervisor Magnús Blöndahl Sighvatsson in Behavioural and Cognitive Psychotherapy. Evaluating the efficacy of an internet-based cognitive behavioural therapy intervention for fertility stress in women: a feasibility study. Below is a picture of us celebrating our publication in Iceland, in October 2022.

You may have noticed that things have been a little quiet on this site lately. That’s because we’ve been very busy collaborating with the University of British Columbia running a Randomized Control Trial. Our work has just been published by the Journal of Medical Internet Research (Impact factor 5.1). It is open access, so you can check it out here:

This is a pretty big deal since the trial shows that AI-Therapy’s Overcome Social Anxiety has approximately triple the mean effect size of 6 stand-alone, internet-based CBT treatments for anxiety and depression (Cohen d=0.24) found in a meta-analysis!

Another amazing was that comparing AI-Therapy’s Overcome Social Anxiety to 19 therapist assisted computerized intervention, was that AI-Therapy showed comparable results. In other words, even though therapist support appears to contribute substantially to the effectiveness of computer-delivered CBT for anxiety, our findings indicated that Overcome Social Anxiety is comparably effective to therapist-assisted interventions when delivered as a stand-alone treatment.

We have known for a long time that AI-Therapy is highly effective, since the program administers pre-post data for its users. But this trial adds to its credibility, since independent researchers at the University of British Columbia tested the program in a randomized control trial. We have lots more in the works for 2018, so please keep an eye on the site! Also visit our Publication page for more information!

Fjola Helgadottir, PhD is AI-Therapy’s director and co-creator of AI-Therapy’s Overcome Social Anxiety. Twitter: @drfjola. Dr. Helgadottir has worked as a clinical psychologist in Sydney, Australia, Oxford, England and Vancouver, Canada. She will be opening up a new service in Iceland in 2018.

Last week was an interesting one, to say the least. It seems like there was non-stop stories about the havoc in the White House. One story didn’t get as much attention as the others (for obvious reasons), but it caught my eye because it made me think about cognitive behavior theory (CBT). I’m talking about Trump’s theory that the body works like a battery. He believes that people have a fixed amount of energy for their whole life, so we should avoid exercise and not overexert ourselves. To back up his theory, he points to all of his friends who exercise and need to get hip replacements and other medical procedures. Trump believes this theory, and he “feels” it is correct. Therefore, he decides to not exercise himself.

What does this have to do with CBT?

Post-event rumination is a central feature of social anxiety. This means that after a social event someone with social anxiety analyzes the interactions in detail to try figure out if they have done or said anything wrong. The problem with this approach is confirmation bias. If we try to uncover evidence for our “social errors” we will find it. This is not because something bad happened. Often we “feel” like we have said or done something that has upset someone. However, just because we feel or BELIEVE we have done this, it isn’t necessarily true. We are looking for supporting evidence after the fact, just like Trump and his exercise theory.

Evidence, evidence, evidence

What can we do to help make better decisions in life? One of the key ideas behind CBT is to become an evidence based thinker. For the exercise theory, a single google search would find scientific articles contradicting the theory. We don’t need to understand the importance of peer reviewed science to understand the many compelling arguments for cardio exercise, such as longevity, mental health etc. In some situations like this we need to trust our gut instincts less, and our brains more.

The same idea applies to looking at post-event rumination. Rumination can become a habit. One may believe it is a useful strategy to make sure they didn’t “slip up” in a given situation. However, this is not productive, and we need to work out a way to limit the time spent ruminating after social situations. We have to understand that most of the time we simply have no idea what another person is thinking. In other words, when we feel they are thinking poorly of us, this is usually without any direct evidence. It is just a product of our own minds, and is best ignored, just like Trumps theory on exercise!

Fjola Helgadottir, PhD is a registered psychologist at the Vancouver CBT Centre, who has previously 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. Twitter: @drfjola

Stop mental health stigma, and start seeking help

A recent study has shown that living with an untreated mental illness lowers life expectancy. Therefore, not only do suffers get less enjoyment from their day to day life, but their lives are shorter. Why is it that people continue to suffer in silence?

Perhaps the main reason that people do not seek treatment is the stigma surrounding mental health. Sadly, this is widespread in today’s society, and there are several reasons for it. For example, we’ve all seen movies where someone commits a horrific crime, and the text at the end tells us that the person is now seeking therapy. This creates an association between anti-social behavior and therapy. This is outrageous, as the vast majority of people who seek therapy are normal, kind and caring people. Some people are genetically predisposed to having mental health problems, while others struggle with negative life experiences. In both cases, seeking help can be a life changing experience, and in neither case should it be something to be ashamed of.

I think it is time to start thinking about mental health problems in the same way as medical problems. If you had a friend or family member who was physically unwell, telling them that “you need help” would be kind and supportive advice. Why doesn’t the same hold for encouraging someone to see a psychologist?

Fjola

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!

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!

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

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Category Archives: depression

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“You need help” should be a positive gesture!