An Online Treatment for Social Anxiety

It’s yet another sign, if such were needed, that psychoanalysis is being eclipsed by cognitive therapy and coaching.

Worse yet, the latest innovation in the field mostly dispenses with therapists.

The website is called Joyable. It offers online treatment for social anxiety. I suspect that it is not bringing any joy to mental health professionals.

Based on cognitive-behavioral therapy the Joyable program involves an initial consultation with a coach and then subsequent follow-up discussions about how best to implement the program.

The Atlantic has the story.

It offers the case of Brett Redding:

Redding, a 28-year-old salesman in Seattle, found himself freaking out during normal, everyday conversations. He worried any time his boss wanted to talk. He would dread his regular sales calls, and the city’s booming housing market—he works in construction—seemed to make his ever-increasing meetings all the more crushing. He was suffering social anxiety, a common but debilitating mental illness.

“I was afraid of losing my job because I couldn’t do it,” he says. His meetings with a therapist weren’t working, and he didn’t “want to mess with antidepressants.”

We do not know what kind of therapy Redding had tried. He might have worked with a therapist who wanted him to get in touch with his feelings. (The reduction ab absurdum of this feeling-based treatment appeared in the last episode of Mad Men. I hope it was intended to be a parody, because it was certainly pathetic.)

He might have found a therapist who tried to help him to deal with past traumas, with the “root causes” of the social anxiety.

Neither of these treatments has ever been shown to be very effective. They are certainly not cost-effective.

So, Redding turned to Joyable. Here is what he found:

Joyable’s website, full of affable sans serifs and cheery salmon rectangles, looks Pinterest-esque, at least in its design. Except its text didn’t discuss eye glasses or home decor but “evidence-based” methods shown to reduce social anxiety. I knew those phrases: “Evidence-based” is the watchword of cognitive behavioral therapy, or CBT, the treatment now considered most effective for certain anxiety disorders. Joyable dresses a psychologists’  pitch in a Bay Area startup’s clothes.

Of course, the company founders want to offer their program to clients who are suffering from other forms of mental illness, but for now they are limiting themselves to the cognitive-behavioral treatment of social anxiety:

… right now Joyable is starting with social anxiety. Why? Among other reasons, it’s the most effective: “CBT is the most effective treatment for social anxiety, bar none—it’s more effective than medication and more effective than other forms of therapy,” he says.

The research agrees. Study after study has shown that patients who are trained in CBT really do get over their anxiety, at a better rate than those using more traditional treatments like talk therapy (though many CBT therapists also deploy talk therapy-like methods).

The theory suggests that anxiety does not come from situations but from the way we interpret situations. There may be little to no danger involved in talking on the telephone, but someone with social anxiety will believe that the situation is fraught with danger. In fact, he will become so scared of the potential calamity that he will not be able to talk on the phone.

Of course, he may have reason for being afraid. Any conversation, any social interaction contains possible pitfalls. We do not speak from a script. We speak with a measure of spontaneity. How do you know that the wrong word will not pop out of your mouth at the most inopportune moment?

Some anxiety is normal. Too much anxiety can be crippling.

Social anxiety, as a psychiatric disorder, involves an excessive fear of something that comports some level of danger. Similarly, as Aaron Beck famously remarked, the objects and situations that cause phobias—snakes, spiders, heights, crowds, etc.-- are, in themselves, dangerous. But they are not as dangerous as a phobic individual believes.

Cognitive treatment does not look for the origin of the social anxiety. It tries to influence the way the mind interprets the situation and to allow the individual to appraise risk rationally.

How does the process work?

The Atlantic explains it:

First, it educates clients about how CBT approaches social anxiety with readings and interactive videos. Then, it teaches clients to recognize anxious thoughts and break them down: This, says Shalek, is the “cognitive” part of “cognitive behavioral therapy.” Finally, there’s the behavioral section, when the website guides users through small, offline activities.

“You do things that make you a little bit anxious, and in doing so you realize that the thing you’re afraid of is less likely to happen—and if it does happen, then you can cope with it,” he says. Typical activities in this phase might include getting coffee with a friend, making a phone call, or speaking up at a meeting.

Clients do not have therapists. They have coaches who function like trainers and who guide them through the exercises.

Evidently, therapists are concerned that Joyable will cut into their business. It costs less than consultations with a therapist. In the same way therapists were concerned that AA and other recovery programs would hurt business… first because they are effective and second because they are free.

What kinds of results do these treatments yield? Brett Redding attests:

When Redding used Joyable, his coach was Steve Marks, the company’s other cofounder. Redding began using Joyable in April of last year and finished the program in July. He couldn’t endorse the service enough. One of his final exercises was a meeting he had to have with his boss. He feared getting fired: She expanded his duties and gave him a raise. Last month, nearly a year later, he found himself promoted again.

“I think CBT is so cool,” he says. “It really works. It’s so, so cheesy, but it does.”