cognitive behavior therapy « 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.

Sarah Woodruff, CRC, LPC a clinical counselor at the Outreach program at the Michigan Technological University (MTU) has received funding from MTU to provide online mental health services to their student population. The grant will offer MTU students access to the AI-Therapy Overcome Social Anxiety program this fall.

AI-Therapy has had great experiences with site licenses in the past. It involves offering students access to the program in a standalone format. It can also be offered by busy therapists who want the student to have access to extensive evidence-based material along with therapy, while the therapist chooses to use supportive therapy. Finally, some therapists create their treatment planning around the modules in the program.

In June of this year, it will be 10 years since we launched AI-Therapy! At the time there weren’t many online programs available, and the Artificial Intelligence boom hadn’t started. People actually read blogs frequently and we wrote a lot of blogs from 2012 to 2015. Since then we have mainly published our information on our Facebook page. In fact, our last post was written in 2018 when our first Randomized Controlled Trial was published. In that study, researchers at the University Of British Columbia in Canada took our program and conducted an independent evaluation and the results were fantastic. Overcome Social Anxiety became a certified blueprint program for healthy youth development! This is a project at the University Of Colorado Boulder that maintains a registry of Evidence-Based Programs that improve the lives of youth.

Since then we have published 7 research papers, two of which are In Press, so I will write about them in my next posts. For the time being, here is an up-to-date publication list. Right before the pandemic hit, we managed to go to the last World Congress in Berlin in 2019:

Please watch this space as these are the titles coming up for our next blogs!

Overview of our latest research (7 journal articles!)
New Online Program: Overcome Fertility Stress
New Online Program: Overcome Death Anxiety
No, Bots and Artificial Intelligence does not mean the same thing in mental health care

Dr. Fjola Helgadottir, Ph.D. is the director of AI-Therapy, runs telehealth and face-to-face practice in Vancouver, BC, Canada. She is a registered psychologist in BC, Canada, and a fully licensed clinical psychologist in Iceland, prior to this she held registration in Australia and the UK as a clinical psychologist. She has 4 degrees in psychology and over the past 2 decades, Dr. Helgadottir has specialized in evidence-based treatment for complex psychological conditions. Her main areas of expertise are Social Anxiety, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, Health Anxiety, Panic Disorder, Agoraphobia, Fear of flying, and more. Dr. Helgadottir has been using Telehealth and innovating in health care since 2007. She received the Tracey Goodall Early Career Award for her innovations in online treatment. Dr. Helgadottir has also been involved in teaching cognitive behavior therapy over the years. Furthermore, she is an active clinical researcher working in collaboration with several universities around the globe. Twitter: @drfjola

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

We all have stereotypes about people with social anxiety. A lot of people falsely believe that social anxiety is the same as being shy. However, this isn’t always the case. In fact, quite often I’m asked “How can I have social anxiety when I’m such a social person?” These are people who enjoy being the center of attention, and who have a constant stream of funny stories and interesting things to say. People like this can actually be the most socially anxious people in the room.

Here is the key to understanding this: people can have social anxiety about different things. Everyone is unique. For example, some people are very confident in job interviews and with regards to the performance at work, but are terrified at the thought of making small talk in the lunch room. On the other hand, some people are very chatty and sociable with their friends and colleagues, but experience debilitating anxiety when it comes to their work performance. Therefore, when clinicians are evaluating social anxiety, it is vital to understand the idiosyncratic differences between people, as these can have a profound impact on cognitive behavioral treatment.

The details vary from person to person, and can be complex, but social anxiety often forms through a process like this:

There is a particular incident in one’s life. e.g. in childhood
People read into these events, and make inferences about themselves. Normally, these inferences involve highly negative interpretations.
People take precautions to try to compensate for their perceived limitation of character.
In reality, the compensations are overcompensation, and over time these behaviours keep the anxiety going.

An example of an overcompensation strategy is “non-stop talking” (hence, the most bubbly person in the room). These people are uncomfortable with silence because they interpret it as “if I’m not participating in the conversation the other person might think I am boring”. It is important to keep in mind that it is not the behaviour itself that is the problem, but the motivation behind the behaviour. It is the WHY that is important. For example, non-stop talking between long lost friends is to be expected.

Other examples include:

always showing a lot of interest in other people’s lives (one of the recommendation in Dale Carnegie courses)
making excessive positive comments
asking a lot of questions
making sure everyone at a party is having a good time

Once again, these are not bad things in and of themselves. It is important to consider WHY you are doing these behaviors. If your motivation is related to how you want others to perceive you, you are probably doing it out of social anxiety

A core part of CBT treatment is to test hypotheses. For example, seeing what happens when you stop overcompensation strategies. It is likely that you find people will accept you for who you are. This is done on an experimental basis, and individuals need to see the point of these experimentation. It is easier said than done, which is probably why therapist have to truly understand the theories behind the strategies they are implementing.

This type of overcompensation strategies are known in the literature as safety behaviors or subtle avoidances. I have recently published journal articles on the topic, and I will be chairing a roundtable at the Anxiety and Depression Association of America ADAA conference in San Francisco on April 8th, 2017 titled: Harmful Safety Behavior or Helpful Coping Strategy? Understanding Client Behavior in the Face of Anxiety.

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.

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