CBT « The AI-Therapy Blog

We are very excited to have arrived in Lima, Peru for the conference. The scientific program is extremely rich, so my biggest problem is selecting which talks to attend. For every hour, there seems to be about 3 interesting talk to select from!

Here we are, the co-founders of AI-Therapy, Overcome social anxiety Dr Fjola Helgadottir and A./Prof Ross Menzies:

AI-Therapy at the World Congress of CBT in Lima Peru

I have two talks coming up. For anyone who happens to be here, please come along and say hi. Here are the details:

Thursday 25th of July at 9-10:20. We will speak about the latest developments in AI-Therapy, in the symposium “Latest developments in online treatments”. There will be some of the world’s leading experts on Internet treatments of evidence based treatments on the panel. Venue: Maria Angola, Room: Las Campanas
Tuesday 23rd of July at 3:30-4:50. We will speak about how the Icelandic financial crisis simulated the origin of Obsessive Compulsive Problems. The discussion will be about general belief in magical thinking, such as the paranormal, horoscopes etc, and how these thinking patterns may influence people’s coping strategies. Venue: Estelar, Room: Arequipa

The next World Congress of CBT will be Melbourne, Australia in 2016, and Ross is a convenor. It is amazing how much work goes into planning these conferences. Even though it is still 3 years away, Ross has been busy planning the 2016 conference for a while now.

First up is the opening ceremony with Aaron Beck, the father of CBT!

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

Earlier this year I presented the Overcome Social Anxiety treatment program to my colleagues in the Department of Psychiatry at the University of Oxford. One of the questions from the audience was: How do you diagnose social anxiety in order to treat individuals? My answer: I don’t.

In the last blog I discussed the controversy around the new DSM-5. The goal of the DSM is to define the criteria for a formal diagnosis. In other words, it helps a practitioner determine whether or not person X has condition Y. I pointed out the shortcomings of this approach. In particular, the severity of a mental disorder is best measured using a continuous scale, rather than a binary classification.

A DSM diagnosis is important in a situation where a patient may be prescribed medication (recall that the DSM is published by the American Psychiatric Association). Most drugs have negative side effects, and they carry the risk of addiction. Therefore, taking medication for mild or moderate cases may not be a good idea. In this case, the DSM plays a vital role in determining who receives treatment. The DSM also plays a crucial role for clinical psychologists, as it guides the diagnosis and treatment of patients.

The situation for online self-help is different. For example, consider our Overcome Social Anxiety program. At the start of the program each user completes a series of standardized questionnaires (e.g. the “Fear of Negative Evaluation Scale” and the “Depression, Stress and Anxiety Scale”). The goal of this assessment is not a diagnosis. Rather, the goal is to determine where the user falls on the social anxiety spectrum prior to treatment. After the user completes the treatment program, they fill out the same questionnaires. The results are compared to the user’s pre-treatment results to see if their symptoms have improved.

We don’t require a diagnosis to use the program since people from along the whole social anxiety spectrum, from mild to severe, can benefit from treatment. The program uses online cognitive behavior therapy (CBT), which is known to be helpful in a wide range of cases. CBT involves revisiting thinking styles and behaviors. Unlike drugs, there are no negative side effects of CBT. Therefore, it can help everyone make better choices in their day to day life. This typically leads to an overall improvement in happiness and confidence, regardless of a DSM diagnosis.

How are social anxiety and depression related?

Social anxiety and depression often occur together, and research has shown that targeting social anxiety can lead to an overall increase in mood and happiness. In this blog we look at an example of how the two can be connected.

A thought pattern that can be a contributing factor to depression is rumination. Let’s consider the following scenario: you’ve been to an evening party, and the first thought that pops into your head the next morning is “Oh no, did I really say that? I wish I hadn’t – I may have offended someone.” You continue to dwell on the thought, and over time your feelings of anxiety amplify. Eventually, you convince yourself that it was a terrible scene, and you become angry and upset.

Rumination following social situations is a common symptom of social anxiety. The social anxiety is leading you to (a) set unrealistic expectations for yourself, and (b) over-analyze the event after the fact. By targeting social anxiety, you will be less likely to ruminate, and therefore spend less time being self-critical.

As a side note, this is consistent with the results that we are observing with our social anxiety program. In particular, there is a (statistically significant) decrease in symptoms of low mood for those who complete the program. Dealing with social anxiety can have follow-on effects that lead to a happier, more fulfilling life.

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!

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…

Website Design

As you may have already noticed, we’ve given the AI-Therapy website a facelift. There are a number of improvements, including easier navigation, more content, and higher quality video. Please take a look, and let us know what you think!

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We also have a new logo, which was designed by the same person who helped us with the new website (Rob Hogg of Skinny Whippet):

Conference Travel

We’re pretty excited to be going to the World Congress of Behavioral and Cognitive Therapies (WCBCT 2013) in Lima, Peru in July this year. This conference is held every three years, in various countries around the world. It provides an opportunity for researchers and clinicians to meet and discuss the “state of the art” in CBT.

I will be giving two talks at the conference:

I was honoured to be invited to speak in a symposium with world’s leaders in online CBT (the other speakers are Gerhard Andersson and Per Carlbring from Sweden, Pim Cuijpers from Netherlands, and Nick Titov from Australia). The title of the symposium is The latest developments in internet-based treatments of common mental disorders. I will be speaking about some of my work at the University of Oxford, as well as the latest developments with AI-Therapy.
My second talk is based on work I conducted with Ross Menzies of the University of Sydney and Mark Jones of the University of Queensland. The title is Superstitious behaviour in Iceland during and after the global financial crisis simulates the aetiology of obsessive-compulsive disorder.

We’re pretty busy these days, but there are exciting times ahead!

fdh

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.

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Tag Archives: CBT

Our new design and the CBT World congress in Lima, Peru

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Conference Travel