safety behaviors « The AI-Therapy Blog

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

A lot has been written about the use of smartphones in social situations – it is the pet peeve of many. People often find it irritating to have a conversation (or eat a meal, watch a film, etc.) with someone who is constantly tapping away at their phone. In this blog I will look at the issue from a slightly different perspective. For those with social anxiety, smartphone use may actually be maintaining their problem.

A safety behavior is an action taken to manage one’s anxiety by exerting (perceived) control over a social situation. It is a behavior or action that is taken in order to prevent the core fear – being negatively judged by other people. Checking your smartphone is a perfect example that seems to be becoming increasingly common. People may do it to avoid something they fear: uncomfortable conversations, meeting new people, awkward silences, etc. In many cases they are worried that they won’t be able to “perform” in the social situation. In other cases, they may want to look important by being online and connected 24/7.

The problem with safety behaviors is that they tend to make the problem worse. On one hand, since it is an avoidance behavior, anxiety is maintained since it is never challenged. Sometimes uncomfortable conversations turn into interesting ones, sometimes awkward silences are followed by deep and meaningful comments, and sometimes when you meet new people you find a friend for life. Being on a smartphone can take away these opportunities. Also, if the social situation goes well despite being on a smartphone, one might wrongly attribute the positive outcome to the smartphone!

To illustrate another point, consider the following scenario:

Alice goes to a party where she doesn’t know many people. She is very anxious, and is worried that the other people at the party will not like her. She spends a lot of time sending text messages, as she hopes this will demonstrate that she is a social person with a wide group of friends. The other people at the party make no effort to engage with Alice, as it looks to them like she has no interest in being there.

As you can see, the safety behavior (checking the phone) is the very reason why people are judging Alice negatively.

I should note that not all smartphone use in social situations is a safety behavior, as it depends on the reason why people are using their phone. There are many other reasons why someone may use their phone, such as bad habit or addiction (I will save that for another blog).

Our social anxiety treatment program can help you identify and challenge maladaptive safety behaviors. I encourage you to think about your actions, and try turning your smartphone off next time you are at a party. Not only are you less likely to be perceived as uninterested in the social situation, I guarantee you will have a richer experience, and you are a lot more likely to make a good impression on other people!

Fjola Helgadottir, PhD, CPsychol, 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

It seems like every time I open Facebook or LinkedIn I see some tips from celebrities or entrepreneurs how to be more confident or successful. In reality, a little talent, a lot of hard work, and some lucky breaks are the key ingredients to success. Yet, successful people have a tendency to attribute their trajectories to a handful of tricks people “must do” in order to succeed. Unfortunately, these tips aren’t always as helpful as they seem. In fact, they can even lead to safety behaviors. If social anxiety is a problem for you, it is important to learn about the role of safety behaviors, and see if you are using them to “play it safe” socially.

This blog post is the first in a series where I will give some common tips, and explain why they are actually counterproductive.

Tip 1. Pretend to be interested in other people

The self-improvement writer Dale Carnegie recommends that people pretend to be interested in what others are saying during conversation. While this may sound reasonable when we are trying to impress someone, it can actually backfire. First, the other person might sense a lack of genuine interest in the topic, and find it uncomfortable that the listener is pretending to be interested. Second, if the social interaction results in a positive response, the pretender is likely to attribute the success to their pretense of being interested, not that they were liked for who they are. Third, this sort of behavior can maintain unhelpful thoughts people have about themselves, such as “I’m so plain and boring”. Every social interaction is an opportunity for people to disconfirm these types of unhelpful thoughts. However, every time safety behaviors are used, an opportunity is missed.

Tip 2. Read over your emails at least 5 times

Many of us overemphasize the importance of wording in our emails. Whilst this may seem reasonable, it simply isn’t always helpful. In fact, some of the most successful people I have corresponded with send me emails full of spelling mistakes (probably due to auto spelling) and no formal structure. Life is too short to read emails more than a couple of times. Try sending emails without proofing them: it’s difficult at first, but then it becomes liberating. It becomes easier to respond from your phone or tablet, and can save you from thinking about the emails when you are doing something else!

In other news, I just had a peer reviewed paper on safety behaviors accepted in the Journal of Speech, Language and Hearing Research. Once it is in press, I will blog about this as well!

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.

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.

There’s definitely, definitely, definitely no logic to human behavior
-BjÖrk

I tend to agree with Björk (my fellow Icelander) — especially when it comes to “common sense” approaches to self help for improving anxiety or mood issues.

Despite having about 1000 trials supporting the efficacy of cognitive behaviour therapy (CBT) in the long term, the average Jane or Joe still has not heard about CBT. CBT has consistently outperformed medication when you look at long term benefits. What you learn through the CBT sticks with you for life! First, it addresses the root of the anxiety by determining what is keeping it going in everyday life. Next, it tackles the underlying cause using experiments and exercises. With CBT you develop strategies that you can use for the rest of your life.

One of the most common ways for individuals to deal with symptoms of anxiety and depression is to purchase self help programs (books, e-books, CD/MP3s audio series, etc.). The quality of these programs varies widely. There are some very good programs out there written by experienced and qualified professionals. Some of the best programs walk the client through the principles behind CBT.

Unfortunately, for every high-quality program, there are many more poor quality programs created by “self-help gurus”. Sometimes these gurus are well meaning people who have managed to cure their own problems, and would sincerely like to help others. Other times they are created by people simply looking for a quick buck. The problem is that some techniques for dealing with mental health issues are counter-intuitive, so without proper training, self-help authors can actually make problems worse. Let’s look at an example.

A typical title for self help books might be: Successful small talk: Learn to be open, interesting and intelligent. The purpose is to advise individuals on how to better manage their impressions on other people in social situations. If only human behavior was that simple! It would be great if we could sit down and read a book that would transform us into interesting and intelligent super-humans. Unfortunately, many of the recommended strategies (e.g. rehearse what you say in advance, make constant eye contact, etc.) can actually maintain anxiety in the long run. I mentioned these processes in my last blog, and referred to them as safety behaviors.

For social anxiety, people often believe that their safety behaviors help prevent negative evaluation in social situations. However, they actually might be preventing them from learning the truth. For example, assume that I deal with my social anxiety by only telling people about the positive aspects of my life (like many of us do on Facebook!). Perhaps I believe that this will stop them from judging me negatively. The problem is that if I never test this hypothesis, I am never comfortable being myself. What is wrong with this?

Firstly, it is unrealistic. People are people, and everyone has their ups and downs. By putting this extra pressure on myself to always look perfect, I might start avoiding social situations, reinforcing the anxiety. Social situations become extremely stressful.

Secondly, this type of safety behavior might make people judge me negatively. For example, people may feel resentful about my “perpetually success”, or suspect that I’m not telling the whole truth. Also, this maintains my social anxiety in the long run since I can never test if people approve of me for who I really am!

On the surface, common sense advice like “people don’t want to hear about your problems — focus on the positive” sounds great. However, as we’ve just seen this isn’t the case. Unfortunately, many self-help books are full of these sorts of recommendations.

There are some great self help books or programs out there. My advice is that if you do follow a self-help program make sure that it is (1) is created by a qualified professional with training in psychology/psychiatry, (2) uses CBT to tackle the core problems, and (3) does not promote behaviors that might end up making the problem worse.