WCBCT 2013 « The AI-Therapy Blog

Quality of life is worse if you have social anxiety

Quality of life measures provide clinicians with information about their client’s “real life”. What do I mean by mean by “real life”? This includes topics like health, self-esteem, goals and values, money, work, hobbies, learning, creativity, love, friends, family, community, etc. People are asked to subjectively assess how satisfied they are with these various categories. Study after study has shown that living with an anxiety disorder can have a significant negative impact in all of these areas. It is important for effective therapy to consider the broader implications of a disorder, rather than focus purely on the specific symptoms.

The World Congress of CBT

At the 7th World Congress of CBT I attended a symposium called “Quality of Life and Anxiety Disorders”. The presenters included leading authorities in CBT, such as Lars-Göran Öst (Sweden), Lisa Liberman (Chile) Ron Rapee (Australia) and Thomas Ollendick (Virginia, USA). I was very impressed with the talks. Several of these researchers are investigating complex topics. As we all know, life is chaotic and complicated, and when we have a better understanding of the intricacies of anxiety disorders we will be be able to devise better treatments.

Quality of life and anxiety disorders at the 7th world congress of CBT: Discussant Thomas Ollendick

The cultural component of social anxiety

As a social anxiety researcher, one study that I found particularly interesting was conducted by Professor Öst of Stockholm University. He compared a group of social anxious individuals from the USA with a similar group from Sweden. He found that social anxiety interfered more with people’s real lives in America.

I asked Professor Öst to speculate on why he thought this might be the case. He hypothesized that it is likely cultural. Being an introvert is perhaps more consistent with Swedish culture. On the other hand, American culture may place a higher value on outgoing personality types. This is not to say that socially anxious individuals do not suffer in Sweden; it is simply saying that there is a cultural component to anxiety disorders that we should consider. Professor Rapee added that similar findings have been found in studies comparing Asian cultures with Western cultures.

The good news for Americans with social anxiety is that there are effective treatments, and these treatments are known to improve overall quality of life. Perhaps this why we are seeing such a strong interest from the US in seeking online treatment with AI-Therapy’s social anxiety program.

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

Last month I attended the 7th World Congress for CBT in Lima, Peru. Conferences are a great way to get up to speed on the latest developments in a field, and this conference was no exception. Overall, the presentations made me very optimistic about the future of online therapy. There is a lot of exciting and encouraging research being conducted.

As part of a symposium on internet-based treatment, I presented some of the latest results from AI-Therapy’s Overcome Social Anxiety program:

Fjola presenting at the CBT world congress — Dr Fjola Helgadottir presenting AI-Therapy overcoming social anxiety at the CBT World Congress 2013

Investigation into real world treatment data

My presentation was somewhat unusual for an academic conference in that it was based on real world data. Typically, talks are based on carefully controlled trials. There is an important reason for this – one goal of a trial is to make the results reproducible by other researchers. This is a key aspect of scientific research. However, there is an important question that is often ignored: will the results translate into the real world? The real world is chaotic, users are not screened, users are not monitored, there is less control over the equipment used, etc. In the past it has been found that treatments that work well in a laboratory environment cease to have the same impact when they are released to the general population. One goal of my talk was to present data from a commercially available treatment program, and contrast this with the latest results from academic systems.

Visitors to the AI-Therapy website

Before continuing, I should mention that all AI-Therapy users are anonymous, and their results are kept strictly confidential. The only data I presented are aggregated, showing average scores across groups of users.

As can be seen in the slide above, we have had almost 20,000 unique visitors to the website since our launch about a year ago. The top 5 countries for visitors are:

USA
UK
Iceland
Australia
Canada

These results are roughly what I would expect. The US is our largest market, but a significant margin. The reason Iceland has made the top 3 is due to some media coverage we have received there.

Effective social anxiety treatment

In order to assess the efficacy of the Overcome Social Anxiety program, I determined its pre-post effect size. When using the program, users fill out a series of questionnaires before starting, and the same questionnaires after completion. The effect size is a standardized measures of the reduction in symptoms over this period (see this page for information about effect sizes, and effect size calculators).

The effect size for the first 19 people who completed all sections of the program was 1.7. An effect size of 0.2 is considered small, an effect size of 0.5 is considered medium, and effect size of 0.8 is considered large. Therefore, an effect size of 1.7 is very large. (It is important to note that this value has been calculated based on people who completed the whole program, and does not include people who started the program, but did not reach the end. We intend to write up a more detailed analysis, and release it as a white paper on this site. Please watch this space.) The primary conclusion is that online treatment programs for social anxiety can be an effective treatment strategy for real world patients.

I am already looking forward to the 8th CBT World Congress, which will be held in Melbourne Australia in 2016. I look forward to seeing the advances that will be made in the online therapy field over the next three years!