social phobia « The AI-Therapy Blog

Blushing

Question: When I blush, is my face as red as I think it is?

Answer: Probably not!

During my postgraduate training at Murdoch University in Perth, Western Australia, I was lucky to be involved with a fascinating research project related to blushing and worry about blushing. The team was led by Professor Peter Drummond, one of the leading authorities in blushing research. ABC Science in Australia published a great article about the work: Fear of blushing brings blush on itself.

For the project I was involved in [1], we looked at the actual physiological changes in people who had fear of blushing, and compared this to a control group. This involved measuring changes in blood flow in subject’s faces while they performed embarrassing or stressful tasks, such as delivering a speech and listening to it afterwards. The results demonstrated that people with a fear of blushing tended to overestimate the extent of their actual physiological change. As Professor Drummond concludes in the article above “it turned out there was very little connection between how strongly people blush and how much they thought they were blushing”. This is good news for people who are worried about blushing, as it suggests that their faces are not as red as they think.

Social Anxiety and Blushing

Professor Drummond’s more recent work examines the relationship between social anxiety and blushing. The results show that social anxiety is one of the best predictors of blushing. Therefore, as the title of the article suggests, the fear of blushing can be a self-fulfilling prophecy. This finding is valuable as it has direct practical implications for the treatment of social anxiety. In particular, it suggests that targeting the fear of blushing (e.g. through CBT) may have wider benefits.

References:

[1] Drummond, P.D., Back, K., Harrison, J., Dogg Helgadottir, F., Lange, B., Lee, C. (2007). Blushing During Social interactions in people with fear of blushing. Behaviour Research and Therapy, 45 (7), 1601-1608. More…

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’m a huge fan of the show “Parks and Recreation” by Amy Poehler. In fact, I even wrote a blog about how much we can learn from the main character (Leslie Knope), who has a fantastic outlook on life. However, I was pretty disappointed when I came across this video of Amy Poehler giving hints about how to deal with social anxiety:

Most of this sounds like common sense advice. However, if you are a regular reader of my blog you will have noticed that all she is doing is promoting “safety behaviours“. She recommends the following:

Breathe
Reach out to a friend (e.g. text message or phone call)
Find a place where you feel more comfortable, such as a corner or couch
Remember that you can always leave without telling anyone

These are classic examples of safety behaviours. Yes, it’s true they may help you get through a particular social event, but the risk is that these behaviours are maintaining the underlying anxiety in the long run. It would be much better to target the thoughts and behaviours that are causing the anxiety in the first place (for example, using CBT).

Don’t get me wrong – I know that Amy Poehler means well, and I’m still a huge fan. However, we have to remember that there is a difference between advice that “makes sense”, and advice that has been proven effective in carefully controlled experiments. Unfortunately, just because you’re a brilliant actress, it doesn’t mean you are up to date with the latest findings in evidence based clinical psychology. Let’s make a deal Amy – you keep rolling out those episodes of Parks and Rec, and we’ll keep an eye on the psychology journals.

For those who are not regular readers of my blog, here are a few that mention safety behaviours:

Consider this situation – you are getting ready for a first date, and you think to yourself “how can I sound intelligent tonight?”. Many of us have thoughts like this. However, spending too much time trying to make yourself sound intelligent can actually be counter-productive. Furthermore, too much thinking about sounding intelligent may be a sign of untreated social anxiety (for more symptoms, you can take our 10 question social anxiety test).

Central to social anxiety is the perceived cost of being evaluated negatively. For example, one might think “if I don’t sound smart, they’ll never agree to a second date”. This type of conditional beliefs can lead people to go to significant lengths to avoid being judged negatively by friends, family, strangers, colleagues, potential romantic partners, etc. The actions used to prevent these undesired outcomes are what psychologists refer to as safety behaviours, which I’ve discussed previously.

One of the problems with safety behaviours is that they are rarely challenged. It’s like you spend your life on one side of a brick wall, but never get to see what it’s like on the other side (where you don’t engage in these behaviours).

Let’s return to dating. A quick Google search has a lot of “helpful” advice on how to impress other people on a date (e.g. see wikihow.com). An example is to always “spend a few seconds thinking before you speak”. In my opinion, this is an example of a safety behaviour, and it can actually be detrimental. Also, a lot of the advice reinforces the idea that a person going on a date needs to spend a lot of time preparing, instead of just being themselves. What are some possible consequences of all this preparation?

1. If the date is successful, you may attribute it to specific behaviours or preparation, rather than the true cause (e.g. they liked you!).

This will reinforce the safety behaviour, and maintain underlying anxieties in the long run. You may never learn that people actually like you the most when you are being yourself.

2. Over-rehearsed communication and presentation can be a turn off.

In other words, it might be a contributing factor to a negative outcome.

3. The preparation can be a lot of work.

In fact, people with more serious social anxiety will actually cancel social events due to all the preparation they feel is necessary before going out. This is sad, as they are missing out on many opportunities in life. Who knows what would have happened if you went for that cup of coffee (even though you were feeling tired, and unprepared?). You may have met a great friend or future partner.

CBT is a technique that can be used to tackle the thoughts and behaviours that are maintaining social anxiety. It can be used by anyone who wishes to be more relaxed in social situations. In my opinion, being relaxed and yourself is the key to a successful first date.

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.

“Fear of failure prevents us from making progress”
– Garry Kasparov, Oxford Union, 9th of November 2012

Last night I went to a debate at the Oxford Union on the subject “Is the current growth crisis a result of decades of technological stagnation in a risk-averse society?”. One of the speakers was Garry Kasparov, who is famous for political activism and for being one of the greatest chess players of all time. In a 2003 chess match he tied IBM’s Deep Junior (after loosing to Deep Blue in 1997), a machine capable of evaluating 3 million chess positions in 1 second. Given Kasparov’s amazing mind, I felt that it was worth listening to what he had to say.

It was a fascinating debate, and both sides made some excellent points. Garry was on the “Aye” side, and argued that today’s technological advances are slower and less impressive than those of previous generations. In particular, he talked about the great achievements of the cold war era in the 50s and 60s. He pointed out that many of today’s “modern” technologies (e.g. the internet) are a direct result of research performed during this time. He closed with a comment along the lines of “the iPhone 5 is nothing compared to Apollo 5”.

Fear of failure prevents people from taking risks, yet taking risks is necessary for progress

One of the topics that was discussed was the reasons why a society ceases to innovate. Garry offered an explanation quoted at the top of this blog – fear of failure prevents people from taking risks, yet taking risks is necessary for progress. This is undoubtedly true, as most breakthroughs are preceded by countless failures.

Garry was talking about societies as a whole, and the risk aversion of government funding bodies and large corporations. However, the same can be said about us as individuals, and I think it has consequences for mental health. For example, consider social anxiety. Risk aversion is one of the reasons that social anxiety doesn’t just go away without evidence based treatments. Social anxiety exaggerates the cost from being wrong, leading to risk aversion. However, treating social anxiety involves challenging your fears and stepping outside your comfort zone. It is worth mentioning that it is well established in psychology that we tend to overestimate risks and the negative consequences of failure.

Returning back to the original talk, Garry was making the point that if our societies are willing to undertake daring challenges, there can be wide ranging positive impacts outside of the original goals (he used the US space program of the 50’s as an example). I would argue that the same holds true for us as individuals. While the speakers were mainly concerned with economic growth, many of their arguments are applicable to psychological growth: overcoming our fear of failure can lead us to healthier and more fulfilling lives.

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.