How-to « 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.

When an anxious person seeks treatment, there is a low chance that they will receive evidence-based treatment recommended by international guidelines (Powers and Deacon, 2013; Stobie et al., 2007).

Computerized CBT programs offer a solution to these problems, given that a computer program can be guaranteed to adhere to effective evidence-based manuals.

The main problem is getting people to use self-guided programs. This is referred to as adherence.

In this study we compared 3 different ways to improve adherence to an evidence-based treatment program called Overcome Social Anxiety with online group sessions:

1) Experimental group. Psychoeducation groups (more cognitive and behavioral work)
2) Placebo group. Progressive muscle relaxation (to control for the extra attention participants were given)
3) Control condition. No group sessions are offered when using the program.

Contrary to our expectations the placebo condition (relaxation group) demonstrated improved adherence. As with so much research, our results leave us with more questions. We are speculating why this is in our discussion session in the following paragraph:

CBT involves strategies which may produce long-term improvements in anxiety and distress tolerance but may not provide a ‘quick fix’ to physical anxiety symptoms. In short, CBT takes time to achieve reductions in anxiety, whilst relaxation strategies do not.
Sigurðardóttir, Helgadóttir, Menzies, sighvatsson & Menzies (2022)

“However, to our knowledge, a link has not been drawn between PMR and increased adherence to computerized CBT programs. One possible reason for the improved adherence could be the instant reduction of state anxiety and psychological distress brought about by PMR (Vancampfort et al., 2013). In contrast, CBT involves strategies that may produce long-term improvements in anxiety and distress tolerance but may not provide a ‘quick fix’ to physical anxiety symptoms. In short, CBT takes time to achieve reductions in anxiety, whilst relaxation strategies do not. The immediate relief brought by PMR may motivate users of the program to continue with it, since they have experienced this momentary lowered anxiety level through relaxation, unlike users who did not have access to the relaxation sessions. “

At last, I would like to congratulate Signý Sigurðardóttir on her first author publication and thank all the other fantastic co-authors for being such top-notch researchers and collaborators! The article is open access which means it is free for everyone to read:

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.

Being in front of people makes you anxious. Sometimes so much so that you can’t speak your mind in social situations, and sometimes skip out on activities altogether. But that’s not the only way social anxiety is holding you back.

1. It’s Preventing You from Connecting with Others

When all you can think about is how fast your heart is beating, or how much you might look like an idiot if you say the wrong thing, it’s hard to focus on what’s going on during social interactions. Social anxiety makes it nearly impossible to reach out to others or interact with them in a meaningful way, for fear of making yourself look bad. After a while, you might begin to feel lonely because you aren’t able to interact with people without severe anxiety symptoms.

2. It’s Causing you Unnecessary Stress

Worrying about all of the things you might do wrong, or something you said years ago will cause a lot of stress to build up in your body. Most of the things you worry about when you have social anxiety are things other people don’t remember, or don’t think are a big deal.

3. It Can Cause Health Issues

All of that build up stress can start to take a toll on your body. If you’re stressed out enough, it can cause you to experience physical health issues that you have to address. Some of these problems include heart disease, headaches, gastrointestinal disease, and faster aging.

4. It’s Actively Stopping you From Living Your Life

How many times have you stayed home from a party or an event because you were too worried about what people would think of you? One of the most common regrets people experience in life is not going out and experiencing more when they were younger. You too might start to regret the things you don’t do after a while.

5. It’s Making you Worry about How You’re Being Perceived in Social Situations

While there are some people who might think you’re a little odd, most of the time people don’t remember you outside of their interactions with you. Most people are so focused on themselves that they won’t notice, or won’t care, if you say something weird, or don’t respond in a certain way.

6. It’s Telling you Things That Aren’t True

When your anxiety gets really bad, it can start to tell you what other people think about you. “That person thinks you’re annoying” or “this person thinks you’re stupid”. There’s no way to tell what other people think, and in most cases, it’s hard to make someone think poorly of you.

7. It’s Stopping You From Pursuing Amazing Opportunities

Have you gone to an interview for your dream job, only to never hear back from the potential employer? Maybe you haven’t experienced exactly this situation, but there’s probably one thing or another that you’ve missed out on because your social anxiety prevented you from interacting in the best way possible.

8. It’s Pushing Your Friends Away From You

Good friends will try to be understanding of what you’re going through. But when you keep canceling on outings, or constantly tell your friends that you can’t make it, they start to think you don’t like them, or that you’re never going to show up. Many of them are busy, and don’t have the time to keep trying to get you to come along. And after a while, they might stop reaching out to you.

Social anxiety doesn’t have to hold you back in so many areas of your life. With AI Therapy’s program “Overcome Social Anxiety”, you can take advantage of years of research through lessons created to help you get control of your fears. Implementing some of these techniques will help you to get your life back, and start connecting with people in a meaningful and lasting way.

We are very pleased to announce our latest collaboration, which is with Dr. Frances Chen and Dr. Chris Richardson of the University of British Columbia (UBC). We will be evaluating AI-Therapy’s cognitive behavior program within the university’s undergraduate student population.

3 years ago I wrote about blog titled: “Is diagnosis necessary for online treatment?“. My answer was no. I believe that anyone can benefit from CBT strategies, whether or not they have an official diagnosis. CBT helps people make better choices in their day to day lives, often leading to an overall improvement in happiness and confidence.

The UBC trial will provide the online social anxiety program to people who have elevated scores on social anxiety, not necessarily a social anxiety diagnosis. We are excited to see the outcome of this research.

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

Can sauerkraut cure social anxiety? Yesterday an article was published in the Huffington Post with the title “Sauerkraut Could Be The Secret To Curing Social Anxiety“. The timing of this article is interesting, as only a few weeks ago John Bohannon conducted a fantastic experiment that demonstrates why you should be skeptical of health new stories. I highly recommend you read the full article. In brief, he conducted a bogus study that appears to demonstrate that eating chocolate helps people lose weight (wouldn’t that be great!?). Pretty soon his results were being reported by media outlets around the world. This exposed several weak links in the way scientific studies are conducted and distributed:

Statistics: There are many ways that statistics can lead a scientific study astray. One of the most common is a process known as data dredging, which involves testing a large number of hypotheses until one is found that appears to be statistically significant. However, effects found in this manner are usually due to random chance. Data dredging is often done unconsciously by scientists who are under pressure to publish results.
Effect size: Even when an effect is real, it is important to know how strong the effect is. In some cases it will be so weak that its impact is negligible.
Peer review: Peer review is one of the strongest tools we have to prevent the publication of poor quality work. However, even this system is flawed. As John Bohannon discovered in another expose, there are many so-called “academic journals” that claim to conduct peer review but will actually publish anything if a fee is paid.
Lack of fact checking: Often a journalist will lift a story directly from a press release without doing any background research about the publication or its authors.
Stories that sell: In order to increase sales, stories are usually given a “spin” to make them more exciting. This often involves catchy, but misleading, headlines, or twisting and oversimplifying the results.

All of these factors contribute to the poor state of health science reporting. It is not uncommon to see completely contradicty stories that are published within weeks of each other.

When you see a headline like “Sauerkraut Could Be The Secret To Curing Social Anxiety” you should resist the temptation to run to your local German deli and stock up on fermented cabbage. Rather, you should base your decisions on research that has stood the test of time, with multiple independent studies showing the same outcome. If you are serious about tackling social anxiety you should use a technique like cognitive behavior therapy (CBT), which has been demonstrated to be effective in hundreds of studies.

Fjola Helgadottir, PhD, CPsychol, is a clinical psychologist, who has 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 program and the author of Flourish: Living happily while trying to conceive. Twitter: @drfjola

For my PhD I created an online social anxiety treatment for people who stutter or stammer. The results were fantastic. In fact, they were so good that Ross Menzies and I wanted to make the tool available for everyone with social anxiety, and that’s how AI-Therapy was born.

AI-Therapy now has hundreds of users from all over the world, and our results (technically known as the program’s “effect size“) have been just as strong as the original PhD version. Actually, they are even more promising as they are now based on a larger population of users.

Statistics aside, it’s also important to hear people’s stories. Unfortunately, the nature of social anxiety makes it difficult for those who suffer to speak openly about the problems. Therefore, I was extremely excited to (quite randomly) come across the following article:

How cognitive behaviour therapy helped me

It was written by a user of my PhD program, and talks about the impact CBT has had on his life. I found it humbling that the program I created made such a difference to someone who has lived with social anxiety for over 70 years.

Here are a few quotes:

The programme was one of the great events of my life. It acknowledged that people who stammer often have undesirable thoughts and beliefs and I was shown how to change these. The results were immediate. The major item I picked up from the programme was the dropping of safety behaviours.

Shortly after the course finished I attended a dinner with 25 people. Normally this would involve the minimum of social conversation from me. On this occasion I made use of the techniques I had picked up and talked just about non-stop and on several occasions I was told to stop talking and eat as everyone was waiting for me to finish my meal so they could have the next course served.

Each conversation that I approach I now face with determination and courage. No longer do I stand back and rehearse what I am going to say before saying it. I have become very outspoken and have no problem at all in speaking up at meetings to add to the discussion. People I have met since completing the CBT programme have no idea that I stammer and when I tell them they are amazed by my story of how CBT changed my life.

I highly recommend you read his whole story. As I mentioned, AI-Therapy’s Overcome Social Anxiety program has been enhanced to be suitable for anyone with social anxiety. I hope it continues to change lives.

Fjola Helgadottir, PhD, CPsychol, is a clinical psychologist, who has 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 program and the creator of Overcome Fertility Stress. Twitter: @drfjola

The AI-Therapy Blog

Category Archives: How-to

New Online Program: Overcome Fertility Stress