depression « The AI-Therapy Blog

One of the things I love about living in Oxford is all of the great museums around. The closest museum to my house is called the Pitt Rivers Museum, and it has the most unbelievable collection of, for lack of a better word, stuff I’ve ever seen. One section that always interests me is called Amulets and Charms, and it contains thousands of artifacts that someone at some point in history believed had magical powers. The exhibit always reminds me of how deeply we desire to feel a sense of control over our lives and environment.

The desire to feel in control is part of the human psyche, and has wide ranging impacts. For example, many people who suffer from depression feel that they do not have enough control over their lives. In contrast, many people suffering from anxiety problems try too hard to control every aspect of their life. In this blog I’m going to take a quick look at some research I have been involved in.

Control and anxiety

Does knocking wood help?

Superstition is an example of one way we can increase our feeling of control. For example, if you knock on wood after saying something you hope doesn’t happen, the superstitious belief is that the act of knocking of wood will magically influence the outcome of a future event in the real world. Regardless of whether or not you actually believe in magic, if you conduct this ritual enough times it can lead to a pattern of learned behavior. If the undesired event does not occur, you may feel like you have contributed to the outcome, even if it was completely outside of your control. Therefore, you get a small reward for knocking on the wood, which reinforces the behavior. In the long run, this can create the illusion that you are responsible for things you have no control over. In some cases this can help maintain a form of anxiety known as obsessive compulsive disorder.

Superstition and obsessive compulsive symptoms

As mentioned above, over time superstitious behavior can lead to people believing that they can impact the outcomes of events which they actually have no control over. As a result, some people develop a strong sense of responsibility. For example, someone may have the obsessive and intrusive thought “if I don’t knock on wood, something bad will happen and it will all be my fault”. This thought is an example of magical thinking, since magic is needed to explain a causal relationship between knocking on wood and an unrelated future event.

Several studies have observed a correlation between magical thinking and obsessive compulsive thoughts. Given this relationship, my PhD supervisor Ross Menzies and his colleague Dr Danielle Einstein had a new idea. Would it be possible to treat obsessive compulsive disorder by targeting magical thinking? The idea is as follows: if someone truly understands that there is no way that knocking on wood will impact a future event, they may be less likely to engage in the compulsive behavior. We took a look at this idea, and our early results indicate that there is some promise to this approach.

References

Danielle A. Einstein, Ross G. Menzies, Tamsen St Clare, Juliette Drobny and Fjola Dogg Helgadottir (2011). The treatment of magical ideation in two individuals with obsessive compulsive disorder. The Cognitive Behaviour Therapist, 4, 16-29

Fjóla Dögg Helgadóttir, Ross G. Menzies and Danielle A. Einstein. (2012). Magical thinking and obsessive–compulsive symptoms in Australia and Iceland: A cross-cultural comparison. Journal of Obsessive-Compulsive and Related Disorders, 1. 216-219

Coming up: Paper at the World Congress of Behavioral and Cognitive Therapies WCBCT 2013, July, Peru, Lima. Title: Superstitious behaviour in Iceland during and after the global financial crisis simulates the aetiology of obsessive-compulsive disorder. More…

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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

There is a well known 2011 study that looks at the brains of London taxi drivers. The map of London is complex, and taxi drivers are required to memorize the complete layout and pass a difficult exam before being given their taxi license. The study found that the hippocampus region of the brain, which plays an important role in memory, actually grows (in a physical sense) while the prospective drivers are studying for the exam. This is an interesting result since it clearly shows that our actions can make real, measurable changes to our brains.

Can you change your brain with therapy?

In short, yes.

Some people view psychological treatments as “softer” than using medication, since drugs can directly target neurochemical aspects of the brain. However, this view is unjustified, since there is mounting evidence that therapy can make very real structural changes to the brain. A great example is CBT.

Cognitive behavior therapy (CBT) is an evidence-based approach to tackling mental health problems, such as anxiety or depression. CBT has been subject to countless clinical trials, and has even been shown to be more effective than medication in some long-term studies. CBT works by targeting the thoughts and behaviours that are maintaining the problem (more information about CBT, and how it can be administered online, can be found here). For example, consider someone who has social anxiety and would like to ask their boss for a raise or promotion. This would be extremely stressful situation for them, and they would likely put it off indefinitely. CBT treatment would examine the thoughts that are leading to this avoidance, and would challenge them through a series of exercises. In much the same way that physical exercise changes the body, these mental exercises can make changes to the structure of your brain!

How does CBT change the brain?

The fact that CBT changes the brain is not a particularly new result. However, neuroscience journals tend to announce findings with headlines like “The neurobiological role of the dorsolateral prefrontal cortex in…”. The details are complex, but the general idea is understandable in surprisingly basic terms.

The brain is divided into different regions or modules, each of which is specialized to perform a certain type of task. For example, the visual cortex is the region of the brain that processes the sensory input from the eyes. There are some brain structures that deal with emotions such as stress and fear, and collectively these are sometimes known as the “emotional brain”. These are very “old” areas of the brain, in the sense that we share them with our distant ancestors. When a socially anxious person is nervous when thinking about asking for a raise, it is the emotional brain that is becoming active.

There are higher order brain structures that deal with planning, logic and reasoning. These are sometimes known as the “logical brain”. These brain areas, such as the prefrontal cortex, are “newer” in the sense that they are much larger in primates than in other species. There are two key points:

The logical brain is able to override the emotional brain. For example, our socially anxious person can take a rational look at the situation, and realize that he or she is exaggerating the potential risks. He or she might come to the conclusion “the worst case scenario is that the boss says no – that’s not the end of the world!” This thought will help them calm down, and build the confidence to actually ask for the raise.
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Every time the logical brain overrides the emotional brain, the logical brain “muscle” becomes stronger and stronger. In other words, through CBT training the brain actually reinforces the neural pathways, so it becomes easier and easier to deal with future stressful situations.

This is good news: by changing our thinking and behaviour using CBT, we are making positive, long term, hard coded changes to our brains!

Arguably no other notable figure in history was so fantastically wrong about nearly every important thing he had to say. – Todd Dufresne on Sigmund Freud in a 2004 LA Times Article

Freud was strange. On one hand, he’s the most famous therapist in history, and I have to admit I was excited to visit his former clinic on vacation in Vienna last year:

On the other hand, his theories are at best unsupported by evidence, sometimes completely ridiculous (I’m looking at you, penis envy), and at worst harmful.

Freud invented a form of psychological treatment called psychoanalysis. One of the cornerstones of psychoanalysis is that our personalities are strongly dependent on events in our early childhood. Obviously, this is true to some degree. We are all shaped by both our genetics and personal history, and childhood experiences can be influential. However, Freud and modern evidence-based psychology differ on how we should go about dealing with our past.

Dealing with the past is a controversial and complex topic. To begin with, there are different types of negative past events. For example, being bullied as a child is quite distinct from a difficult breakup. Therefore, the specific treatment will depend on the individual and their circumstances. I will not attempt a full literature review of this active research area, but I will make two general comments.

1. We can’t change the past, but we can change the way we think about the past.

It is important to acknowledge the negative events of our past, but unlike psychoanalysis, we must realise that they do not determine “who we are”. We are capable of living happy lives if we learn to think in a more rational, positive way. How can we accomplish this? If you’re a regular reader of my blog you will know what I’m about to say: cognitive behaviour therapy (CBT). CBT does NOT adhere to “just get over it” attitude. Rather, the goal of CBT treatment is to identify and target the unhelpful thinking patterns in the present that are maintaining the problem. Ultimately, the aim is to get to the point where these memories no longer upset us. In a sense, CBT therapy really isn’t about the past at all.

2. Dwelling too much on the past is not good for our mental health. However, if not the past, what should we be thinking about? When are we happiest?

“Live in the moment” is common advice, and in this case, it seems to be right! There is some interesting research that shows we are happiest when we are absorbed in what we’re doing, not letting our minds wander. CBT also has strategies to help people accomplish this! I try to do this as much as possible, while taking the occasional break to plan my future using my nerdy excel method.

These two points have something in common: the present. Since Freud’s time, it seems we’ve learned that living in the present is the key to dealing with the past.

I have blogged before about my a love-hate relationship with Facebook. At its best, it is a great way to keep in touch with people and see what everyone is up to. However, the downside is that Facebook presents us with a biased and filtered view of the world. This is partly because we have a tendency to present ourselves the way we wish to be seen, rather than the way things are. Our friends are having non-stop fun, their babies never cry, they globe-trot to exotic locations, they bump into celebrities, they always have funny and insightful things to say, etc… This is why a good friend of mine calls it “Fakebook”.

It seems to me that in the early days of Facebook (way back in the mid to late 2000’s) people were more “real”. They were less concerned about their online image, and much more open. In fact, if you’ve had an account for more than a few years, it can be very interesting to use the timeline feature to see what sorts of things you were writing publicly on your friends’ walls a few years ago.

In general, spending too much time on Facebook is not great for your mental health. This blog is about how can we prevent Facebook from having a negative impact on our mental lives, and maybe even lead to increased happiness. I’ve included a few tips below, and would be happy to hear of any other ideas.

Tip 1. Moderation

The first tip is obvious but important: don’t spend too much time on Facebook. As with pretty much anything, excessive use leads to trouble. How much is too much? Well, that depends on the individual, I set myself daily limits, but I would say that you shouldn’t spend more than a few hours a week on the site. The tricky part is cutting back, because sometimes we head to the site as an unconscious reflex whenever we have a free minute. I’ve found the following helps limit my usage:

I’ve turned off all the notifications that are sent to email/my phone
I try not use it in social situations
I make a point of leaving my smartphone at home when I truly want to relax

If this is proving difficult, one way is to use the Chrome browser and install the StayFocused plugin.

Tip 2: Limit updates from certain people

Sometimes we have connections on Facebook with people who we are not that close to, and for one reason or another they do not have a positive impact on our happiness. It is important to make sure that updates from these people do not come up in your news feed (use the “unsubscribe” option).

Tip 3. Don’t rely on Facebook for updates from important people in your life

My sister is due to have her third baby around Christmas. Obviously, I want to know everything there is to know about how things are going for her. However, I miss lots of her Facebook updates because they don’t always appear in my feed. This is because an algorithm somewhere is deciding which posts to show me, and which ones to skip. Take a moment to think about this. Given that over a billion people use Facebook, this algorithm has incredible power and influence over the flow of information in the world. Always keep in mind that you may miss important updates, and that there is no replacements for old fashioned phone calls and catch-ups.

Tip 4. At the end of each year, use the timeline to find highlights from each month

My husband and I have a tradition that we’ve kept alive since we first met in 2006. Sometime between Christmas and New Years we create a calendar to use for the upcoming year. For each month of the new year we select a “happiness highlight” photo from the same month of the previous year. For example, here is the June 2009 photo, which we took when we went hiking in Greenland in June 2008:

Not all photos have to be from significant events; sometimes we can have very fond memories of normal day-to-day activities. Our only rule is to pick photos that make us happy.

What does this have to do with Facebook? Well, it used to be very long process for us to gather all the photos from the previous year and arrange them by date. However, Facebook’s Timeline feature now does this for us. Many photos end up on Facebook these days, and as I said earlier, there is already a bias towards highlights. Therefore, it is a perfect way to review the past year, and pick out some great photos. In fact, customized calendars, cups, mouse pads or whatever are great Christmas presents.

My husband and I always get our calendar printed, and it serves as a great memory of each year. However, even if you don’t print a calendar, it is still a good idea to make the most of Facebook’s record of our lives. Think about the times when you were happiest. What do they have in common? Facebook allows us to take an empirical look at ourselves, and we can use this information to make positive changes. So, to answer the original question “can Facebook make you happy?”. I would say yes, if you use it wisely.

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.

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Category Archives: depression

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