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.

A recent study says “yes”!

Online therapy is an active and growing area of research in clinical psychology. In fact, there was a symposium devoted to the subject at the recent World Congress of CBT in Lima, Peru (which I was honoured to be a part of – to be covered in a future blog). Perhaps the most important question that researchers are trying to answer is: “Does online work as well as face to face therapy?”

This is a difficult question to answer since there are so many hidden variables. In fact, there is no universal answer, since it depends on the particular online system being examined, and the skill level of the therapists involved in the study. A better questions is “Can online therapy work as well as face to face therapy?” In other words, are there any online systems that can match the results of live therapists for a specific problem? According to a recent publication, the answer is “yes”!

A team of researchers from the University of Zurich published the following paper:

Birgit Wagner, Andrea B. Horn, Andreas Maercker. Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders. July 23, 2013. (see this link for more information)

The authors conducted a study involving 62 people with moderate depression. Half of the patients were treated using traditional CBT in-person techniques, and the other half were treated online. The authors found that at a three month follow up, the patients who were treated online had fewer symptoms of depression than the control group. In other words, the online treatment program actually performed better than the face to face therapy.

Advantages of online therapy

I have discussed some of the advantages of online therapy on this blog and in my publications. These include:

Clients can progress at their own pace
Clients have a complete record of their treatment, which they can revisit at any time
“Therapist drift” is a known phenomenon, where therapists move away from the best practices of a particular treatment over time. With online treatments, it is easier to enforce a consistent treatment, with the correct “dose” of clinical content delivered during each session.

Of course, online therapies have challenges of their own. In particular, it is more difficult to adapt the treatment towards the individual symptoms and needs of the users without therapist involvement. In fact, it is this problem of individual personalization that AI-Therapy’s social anxiety program attempts to address.

More studies are needed to fully investigate the strengths and weaknesses of online therapy. However, the study above adds to a growing body of evidence that online therapy has tremendous potential, and will play an important role in the future of mental health treatment.

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

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!

Social anxiety is a persistent and chronic mental health problem¹. It is estimated that between 7%-12% of people experience social anxiety at some point in their life². This means that it impacts from four to seven million people in Britain alone!

The problem of social anxiety can come in many forms, such as extreme shyness, or worry about negative evaluation by other people. It is often persistent throughout an individual’s lifetime, and therefore determining the age of onset can be a complicated matter³. Research data on childhood social anxiety is scarce⁴ , but several authors report that onset is typical in the mid-teens or early adulthood⁵.

The vast majority of people who struggle from social anxiety never seek any treatment.⁶ It is widely established that a social phobia diagnosis is frequently missed in primary care worldwide.⁷ The shame and embarrassment that lie at the heart of social phobia are highly likely to be contributors to this phenomenon. Indeed, the embarrassment is the primary reason why socially anxious individuals do not report their symptoms to their family doctor⁸. In a study of 9,282 individuals it was evident that those with the most severe social phobia were the least likely to receive treatment⁹.

Astonishingly, once the diagnosis has been made, it can take up to 17 years for treatment to be sought.

One solution is online CBT treatment for social anxiety

Given the above problems, there is a strong need to find and facilitate ways to make it easier for socially phobic individuals to seek and receive professional help¹⁰. One of the goals of AI-Therapy is to address this problem. The core ideas were developed as part of my PhD research, but have now been extended to be an online self-help treatment for a wider audience. One goal behind this method of service is to reach those who would never make into a psychology clinic in the first place. Furthermore, it provides an option for those who, for one reason or another, are unable to see a psychologist on a regular basis. Finally, the anonymity of online therapy can be an advantage for some clients.

1) Yonker 2003

2) Furmark, 2002; Kessler et al., 2005; Ruscio et al., 2008

3) Rapee, Schniering, & Hudson, 2009.

4) Rapee et al., 2009

5) Antony & Rowa, 2008; Antony, Federici, & Stein, 2009; Hofmann et al., 2009

6) Beck & Clark, D. A., 2010.

7) Beck & Clark, D. A., 2010; Lampe, 2009.

8) Davidson, 2007

9) Ruscio et al., 2008.

10) Beck & Clark, D. A., 2010; Lampe, 2009.

The six decades of excitement over Artificial Intelligence

Fresh air blew over the field of artificial intelligence (AI) in the 1950s. The initial excitement and optimism of its founders is well described by the famous quote of Herbert Simon: “I believe that, in our time, computers will be able to do anything a man can do. I believe that computers already can read, think, learn, create” (Simon, 1965 p. xiii). Yet the task turned out to be much harder than early researchers anticipated. For example, it took another three decades (1997) for the first computer to outsmart the top human chess player (IBM, 2010). This was unexpected, as chess, with its rigid and well-defined rules, seemed like an easy target for computers to master. Even in this case, the victory in 1997 was primarily due to the use of massive supercomputers and the availability of raw computational power, rather than the successful mimicking of human strategy, game play, and intelligence. Despite initial optimism, understanding and reproducing true intelligence (in a human sense) continues to be well beyond the reach of modern AI.

Eliza was a computer program that was released in 1966, still in the early days of the AI movement. The program responded to its users questions and statements that they typed on a keyboard. In many cases the users were convinced that a real person was behind the scenes (Weizenbaum, 1966). However, Eliza was fully automated, and based its output on algorithms that parsed the user’s input and formulated responses based on a programmed model. The model was designed to imitate the style of an empathic therapist using the Rogerian approach (Rogers, 1951).

Artificial intelligence and clinical psychology

Eliza was the first use of automation to create the illusion of human-human clinical interaction through a human-computer interface. In general, little progress has been made towards algorithmic techniques that are useful for treating mental disorders. The original goal of Eliza was to demonstrate and advance AI technologies such as natural language processing and pattern matching. In contrast, the goal within the clinical psychology community should be the application of these techniques using evidence-based treatment strategies to tackle real world problems. The development of fully automated therapists that are indistinguishable from human therapists remains an unsolved problem, and will continue to be for the foreseeable future. However, there are techniques currently available in the psychology literature that are suitable for automation, when treating specific, well-defined conditions.

A “computer psychologist” has been developed for AI-Therapy that can identify specific problem areas that patients report, and design individualized formulations and tailored treatment components with corrective feedback. Importantly, the computer psychologists has variety of strategies in place to direct the user in such a way that errors made on behalf of the users are kept to a minimum. As an example, participants are not asked to tell the program what unhelpful thoughts they experience, but rather the program offers suggestions based on file audit data and the clinical experience of developers. In this way, the computer psychologist is able to propose tailored cognitive behavioural therapy (CBT) techniques, such as cognitive restructuring exercises, behavioural experiments, etc. Furthermore, sample answers were written for over 1000 of the possible situations that a client might encounter, allowing the “computer psychologist” to give automatic corrective feedback. The advantage of this is that this knowledge and experience can be made available around the globe and accessed by an unlimited number of people at the same time.

For more information about AI in clinical psychology:

Helgadottir, F. D., Menzies, R., Onslow, M., Packman, A. & O’Brian, S. (2009a). Online CBT I: Bridging the gap between Eliza and modern online CBT treatment packages. Behaviour Change, 26 (4), 245-253. Cambridge Journal More …

Nobody sat down and decided to create the Internet

In March 1989 the blueprint for the Internet were sent by Tim Bernes-Lee to his boss at CERN. It had the humble title of: Information Management: A Proposal. The comment he got back was “Interesting, but vague”, but he was allowed to continue to pursue this Information Management System. It’s creation was motivated by Tim wanting to communicate with other researchers around the world. For this he created what we now know as the Internet. It certainly is not exclusive to nerdy researchers anymore, more accurately it takes up most of our waking lives!

The community needs better access to evidence based techniques

AI-Therapy.com came about in a bit similar manner. I was finishing my clinical psychology Internships in Sydney, Australia. However, before my last year had finished I was awarded a prestigious PhD scholarship at the University of Sydney. There was a major dilemma, do I miss out of this exciting scholarship award which was funded to respond to the need for evidence based treatments using the internet, or do I not finish my clinical psychology training/internships?

From this AI-Therapy was born.

My solution to this problem was to generate a fully automated computer psychologist which could be treating people online simultaneously with me working at the various hospital settings for my internships. It turns out, that to solve my problem of doing two things at once, I created a product which helped bridge the gap between the need for access to evidence based psychology techniques in the general community. After many years of hard work, I am pleased to announce that this service is now available to the general public under the name of AI-Therapy overcome social anxiety. You can see how it works here.

If you are interested in the original research for this computer psychology service, please refer to the following research and the associated publications

The AI-Therapy Blog

Tag Archives: online CBT

New Online Program: Overcome Fertility Stress