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Oh Pod! x UCL is a co-produced podcast tackling the taboos of healthcare issues. In this series, Shakira and Iman have insightful conversations with leading academics about common health related misconceptions, covering everything from anxiety to perinatal mental health. Each month Shakira and Iman are joined by a leading academic to offer their perspective on the big questions, cut through frivolous news and to de-bunk urban myths. Oh Pod! x UCL is a warm, inclusive, and inviting podcast. Episodes are aimed at the public. They are understandable to individuals from all levels of education and backgrounds, with no science experience required.
Led by Dr Rupy Kaur Matharu & Dr Shoba Poduval.
Brought to you by UCL and Waltham Forest Future Formed.
EP3_UCL.mp3
Iman Issa-Ismail [00:00:00] Hello and welcome back to a pod. Today we are doing the final segment of the collaboration with UCL, and we'll be discussing anxiety today with Doctor Oliver Robson.
Shakira Crawford [00:00:10] Thank you for speaking with us today. Doctor Oliver Robinson. Your title is Professor of Neuroscience and Mental Health. What motivated you to pursue a career in mental health, and what are some key questions you were trying to answer in your research?
Prof Oliver Robinson [00:00:23] So I've always been interested in people interested in how people behave and how they react, which made me, you know, interested in psychology. And yeah, trying to understand what makes people tick. I also, you know, when I was doing my A-levels and stuff in school, I was really interested in biology, and like more sort of, you know, not humans as a whole animal, but like more cells and how things. And so that led me also interested in like neuroscience. And so basically throughout my career, I started, you know, I've been studying the brain, studying how the brain works, and then also studying how humans interact. And, then psychology. And so sort of marrying the two together. That's where my title comes from. I'm looking at the neuroscience aspect. So how the brain works and then, but then also the mental health aspect of it. So psychology and how people interact with each other. So broadly speaking, what I'm interested in is how do common mental health problems occur. At the level of the brain, like, you know, everything that we do is contained within the kind of constraints of our body, not just the brain, but also the whole rest of you you've got in your stomach and so forth. But it all is coming from within here, obviously, in reaction to what's happening in the environment. But like the feelings are coming from within here. So that's what we're trying to understand. It's also a really difficult challenge. Like we don't really know anything about the brain. We know, you know, we're all right at treating mental health problems. But there's an awful lot of people that we're unable to treat. And so a better understanding of this kind of thing, you know, in addition to being fascinated in it, I also think it's really important to be able to help people. So yeah, so that's, that's that's, broadly speaking, what got me interested in it. But, you know, it's going to keep me going for a whole career because as I say, it's super complicated. We're not we're not nowhere near to fully understanding anything or really close to solving any of the problems that we have, unfortunately. But we're getting there.
Iman Issa-Ismail [00:02:09] The clinical term for anxiety and depression is psychological distress. Can you explain what psychological distress might look like?
Prof Oliver Robinson [00:02:17] So psychological distress. Distress is a term. It's not the only term that describes anxiety and depression. Anxiety and depression, you know, their own things in a sense. But what's common to both of them is some degree of psychological distress. What's kind of interesting, especially about anxiety, is that in addition to, you know, their normal feelings, everyone feels anxious, like it's actually useful, like perhaps when you're doing a podcast or whatever, you might feel a little bit anxious. And that's it. That's helpful. It gets you on your toes, makes you a bit more focussed. Or, you know, if you think about a more traumatic environment, walking home in the dark or whatever, you feel a little bit anxious that's going to prime you to detect the stranger lurking in the corner or whatever. That's a helpful, emotion. And so you could say it's psychologically distressing, but it's also useful. Right. But what happens with, anxiety disorders and depression is that useful function. You might also experience it at other times. And that's when we might refer to it as sort of distress, psychological distress. So the example of walking home in the dark, you might feel anxious, anxious, anxious. And you get home, you're having a cup of tea. Everything's safe. You're all okay. That anxiety should slowly dissipate, right? But in some people it doesn't. It stays right and it stays throughout the day, throughout the night. And it ends up getting in the way of, you know, going about your daily life. So with anxiety, what can happen is one one example is, you know, especially with social anxiety, people might find themselves like really worried about, you know, embarrassing themselves. Right? So I don't want to go out and to that party because, you know, I'll say something stupid and then I hate myself. And what that ends up doing and in extreme cases is people might not leave the house. Right. And so that's an example of, of where that kind of feeling which can be useful becomes more pathological. And it's, you know, within the realm of psychological distress. The thing is, when it comes to these mental health conditions, you know, we have terms that we use colloquially. I'm anxious, I'm stressed or what have you. There's terms that are used clinically, like, you know, generalised anxiety disorder, post-traumatic stress disorder, you know, distress and things like that. The definitions are kind of sometimes useful, sometimes not useful. I mean, fundamentally, the thing that makes something a problem is only known to the individual and the people around them, right? Because for one person, some kind of extreme trauma is, you know, more of a text back for another person. It's getting in the way of their life. And so where you draw that boundary is going to depend on the individual, and, and, and their experiences. But you know, we don't it's not necessarily helpful, I think, to get caught up on terms or diagnoses, like some people find it very helpful to put a label on something. Some people find it not helpful. So, you know, it's all a bit blurry, basically. But yeah, that psychological distress would be something where it's getting in the way of your ability to go about your life, basically.
Iman Issa-Ismail [00:04:58] So the other one. More like flight or flight, like every day.
Prof Oliver Robinson [00:05:01] Yeah. So fight or flight is is again, that's more like, the adaptive function. You know, you're in the forest and you see a bear, right? And it's always a bear. And these examples, we are bears. But, you know, you see a bear and you're like, oh my goodness, what do I do? Do I run away or do I fight the bear? Right. I mean, if you're crazy, you fight the bear, obviously, then you die. But, but that is a normal adaptive function to seeing a bear, right? But if you have that fight or flight response, you know, when you're just talking to the person at the ticket counter on the tube, that's not helpful at all, right? Because you're just trying to buy a ticket for the tube or whatever. So it's when that thing that can be useful in certain circumstances is engaged in appropriate times, that then we think of it more as a disorder. But, you know, most people are going to oscillate between periods of this. And, you know, everyone at some point will feel anxious. Everyone probably at some point will feel anxious inappropriately at least, you know, in their minds, but not everyone does it become crippling and preventing them getting on with their lives. So, you know, I think it's better in a sense, to just not worry too much about the terminology when it comes to mental health, and it's more about the individual when it comes to the science. On the other hand, obviously we have to be quite specific and precise about the definitions, and we can talk more about that if you want to. But from the sort of, you know, as someone who feels anxious, it sort of doesn't matter too much if that makes sense.
Shakira Crawford [00:06:18] That sounds a lot like social anxiety, where if you're in a social environment and you have a fight or flight response, yeah, that sounds a lot.
Prof Oliver Robinson [00:06:24] So yeah. So so the clinical term would be social anxiety disorder. Yes. It's exactly what it is if, if, if your anxiety is associated with that particular environment. But we have different flavours of anxiety disorder based on, you know, the environment generalised anxiety disorder. It's kind of like it could be social. It could be, you know, worrying about being in a car crash or worrying about, you know, whatever likes of general stuff. Post-traumatic stress disorder is obviously social anxiety, but that's with a clear traumatic event beforehand. They're all flavours of, of of a disorder, as it were, that are associated with anxiety. No one is, you know, easier to deal with than any other, really. But sometimes when you know what the cause of the problem is, in the case of social anxiety, then that can lead to certain types of treatments. And so for example, one of the most successful psychological treatments. So when we treat anxiety disorders we have medications and we have psychological treatment. Some work for some people, some work for other people, some work for nobody. So some people don't. Neither of them works for for some people, neither psychological, no pharmacological, medication work. But when when it comes to psychological treatment for social anxiety disorder, one of the kind of key treatments actually is to make people face their fears, as it were. So if you're worried about a social environment, social situation, generally what it is you're worried about is, oh, I'm going to embarrass myself, and then everyone's going to think I'm an idiot, right? That's often a symptom that people have. So one of the solutions is, okay, let's go and have a social environment. Maybe we'll organise it, maybe go to the party. And then tell me afterwards how did it actually go, you know, and then you go to the party, you come at you. Well, I didn't embarrass myself that time. Okay. That's good. So what you were doing was you were telling yourself that was going to happen, but it didn't happen. So maybe the next time, think about it. And then maybe you go to the things you have. And it's actually very effective for some people, basically facing their fears, as it were.
Iman Issa-Ismail [00:08:17] Is like exposure therapy.
Prof Oliver Robinson [00:08:18] It's exactly what is called especially therapy. Yeah okay. Yeah, yeah. That's right.
Shakira Crawford [00:08:21] You published a paper in 2019 called what Does The Hitchhiker's Guide to the Galaxy have to do with our understanding of anxiety and depression symptoms? Can you share what you found?
Prof Oliver Robinson [00:08:32] Yes. So that actually was a sort of. What's the word I'm looking for? It was a kind of, an addition to a paper. The paper itself was kind of a dry scientific paper. I can't remember what the title was, but it would have been quite boring. This was kind of like a more fun summary of it to try it, you know, to hopefully make it a bit more interesting for, for for people who want weird AI, people who want scientists. But so basically, what that was about was, we're trying to use sort of new technology to understand anxiety. So you'll have you'll be familiar with artificial intelligence, and you know how this is going to take over the world. But it's also quite useful tool for people like us because we can, develop artificial intelligence agents or robots. You know, they're not really robots. They're in computers. But let's call them robots for fun. And, we can make them do stuff. Right? So one of the things we have in anxiety is that, it changes how you behave. And it changes, how you might respond to choices. So if I give you a choice between going with A or B and A is, let's go to A or, you know, you've gone to restaurants, one is better than the other. If you're anxious, you might go for the restaurant that you know to be better, for example, even though the one that's that's worse might have, you know, one really good thing on the menu, but the other stuff is bad. I mean, this is not a great analogy, but anyway, the point being that if you're anxious, it changes how you make these choices. Okay. Now, if you can, if it changes how you make choices, what we can do is we can make robots that also make those choices, right? And we can change the the sort of workings of those robots to make them behave like the anxious person. Compared to like, a control person. That's what we did in this, in this study, actually, is we had people do a very simple task, which is a bit like choosing restaurants, which is why I got stuck in that stupid, stupid analogy. But we had lots of anxious people and lots of healthy individuals. Real people perform these, simple computer games where they're making these choices. And what we see is that the anxious people perform differently. And actually what happens is the anxious people, if something bad happens after a choice, they're less likely to choose that again, which makes sense, right? You're anxious. You don't choose a bad thing again. Okay. But we don't know why and what causes that. So what we can do is take that data, and then we can essentially train our artificial intelligence agents. We can train our robots to behave and perform that task. What that means is we can basically make this army of artificially intelligent agents that perform like the anxious individuals. The reason that's like Hitchhiker's Guide to the Galaxy is what we've done is we've made an army of robots that are like people who aren't anxious, an army of robots that are like, anxious individuals. Now, in Hitchhiker's Guide to the Galaxy, there's a character called Marvin the Paranoid Android, which I'm probably dating myself, with this reference, I think Hitchhiker's Guide to Galaxy came out like, 70s and 80s or something, but it's also referred to in the the Radiohead song Paranoid Android, which came out in, I don't know, probably the 90s again, dating myself. So, Marvin the Paranoid Android, it's a joke, right? It's an anxious robot, right? He's roaming about the spaceship going through. Everything's terrible. Things gonna be bad, right? It's kind of silly, right? Why would you build an actual robot? Right? Well, the reason we did that we built anxious robots is that once you've done that, you can actually start to pull apart what you've done in new sort of AI mechanics. The machinery. Oh, we tweak this, this call good, this parameter, this bit of code or whatever. And that's what's changed the behaviour and it's made them behave like an actual individual. And cut a long story short, there's lots of different parameters, lots of different ingredients that can change the way you behave. And in that one study, what we showed is it's something called the aversive learning rate that changed, when people were anxious or our robots were anxious. And what that means is when people are anxious, it's not so much that they dislike bad things more. I if you're anxious and I give you a bad piece of news and you're not anxious, I give you a bad piece of news. It's not like the anxious person finds that bad piece of news more aversive AI. They don't like it. Nobody likes bad news. Everybody dislikes bad news. What's different about anxious individuals is how quickly they change their behaviour in response to that bad bit of news. So whereas someone who isn't anxious might get that bad news. Day one, day two, day three okay, finally, I might change my decision. Someone who's anxious might change it immediately. Right? And we see this clinically. So, a common anxiety problem is, is fear of, like, problems happening on public transport or like a plane crash, for example. Now, we know plane crashes are very, very rare. So if you hear about a plane crash on the news, you might go, well, you know, that's terrible. But, you know, loads of planes fly and they don't crash every day. But if you're an anxious person, you hear about that. You might be writing them flying ever again. What that means is you change your behaviour very much faster in response to that bad piece of news. Now, we were only able to get to that kind of particular mechanism of anxiety by going through this whole process of building this army of anxious robots, if that makes sense. And this is a part of a field, it's got a new ish field called computational psychiatry, which is basically trying to use the tools of computer science, artificial intelligence and things like that to model the computations that the brain is doing that leads to anxiety. Now, this isn't going to help someone immediately get treatment, but that bit of information, okay, it's about changing your relationship with, your behaviour and how you change your behaviour in response to bad news that could eventually help us, you know, tailor therapies to individuals, for example. So rather than try to tone down how they respond to something, you know, maybe you should, you know, well, like we talked about with exposure therapy, do the thing again. Do the thing again and don't change your behaviour. Do the thing again. Don't judge me okay. Was it fine. Yes it's fine okay. So now we're modifying your your learning rate as it were. but yeah. So basically in that paper we try to build anxious robots basically is where the title come from.
Shakira Crawford [00:14:00] Can I bring up. Sorry quickly. Yeah. It was in the teams meeting that I watched. You basically said that you shock therapy.
Prof Oliver Robinson [00:14:07] No, no, no. So not shock therapy. Next we say shock therapy is a specific type of treatment for, treatment resistant depression. Electric. So electrical electroconvulsive therapy, it's the one that you see in, like, One Flew Over the Cuckoo's Nest, right? It's the what? The sort of example of, like, you know, terrifying psychiatry. Like strapping people down and shaking their heads. Now it is actually still used. Yeah. And it's used in, in very rare, not that semi rare cases where nothing else works. And it is actually pretty effective. Now these are people who, you know, their depression is so bad that they maybe had multiple suicide attempts. They can't really do anything. Like everything is extremely traumatic. And in a few of those people and you know, it's not without controversy. That's true. But it is a recommended treatment for people for whom nothing else works, basically. And it might be the choice between something like that. And it works for you versus, you know. Eventually even taking their own life. So it's like it's a very extreme type of treatment, not used very commonly, and certainly not in this sort of anxiety depression we're talking about. Now, this is extremely common. This is like something like 20, 25 to 50% of people experiencing symptoms. You'd never be getting electric electroconvulsive.
Iman Issa-Ismail [00:15:17] I'm never worried about that.
Prof Oliver Robinson [00:15:18] Yeah.
Iman Issa-Ismail [00:15:18] Get to that.
Prof Oliver Robinson [00:15:19] But but what we do do so not we don't do shock therapy. What we do is we use electrical shocks as a tool to understand how, what happens in anxiety. So, and the reason we do this is because different people might find certain things. And so some people hate spiders, for example, I don't mind spiders. Yeah. They get you hate spiders. Right. So we could try to study your anxiety by using a spider. Sorry. I'm doing again. We could try to study your anxiety by using a spider as a, as a sort of negative q as a as a bad thing. But that will only work for you because you don't like spiders. Wouldn't work for me because I don't mind spiders. Now, the thing about electrical shocks is, what we do is we will attach them to people's wrists or ankles. Right. And we can give you a little bit of a shock and you get out, it bother me, and we can get it to a point where, keep increasing it and everyone at some point. I don't really like that. Okay. Now it's not like extreme agony, right? The example is the feeling of an, elastic band, like slapping against your skin. So it's not awful, but it's not fun. Right. But the advantages that we can change that for different people. And we've got now a stimulus unlike a spider that everyone doesn't like. Okay. So now what we can do is we can study how you behave in response to that negative outcome. So one of the things we do, in our studies is we look at when we tell you, okay, that shock that you don't like at some point that's going to happen. Right. So imagine I'm asking you to do a simple computer game. And normally you're just playing that game. Right? But then I go, okay, right. Can continue playing that game, but at some point you're going to get electro shock, right? It's got nothing to do with your the game itself, but you just that might come at some point. You're probably going to be like this is horrible. What what are you doing to me. Right. So that is anxiety, right? That feeling of expecting this bad thing to come is the feeling of anxiety. Right. And so we can then say, now you're safe, now at risk, now safer. And we can look at how it changes your behaviour. And that's actually what we did in that study with the robots, is we looked at how healthy people's behaviour changed when they were at risk of getting electrical shock when they went. And so we're making healthy people anxious and then not anxious. Okay. So now we can use that as a way of studying, studying the anxiety. But it's a way that works for every single person. Now obviously all of our studies are, you know, voluntary with consent. And probably there are certain people who would never participate in one of those studies because I don't want to get electrocuted. Right. So we're actually studying probably a slightly biased sample of people. But it's one of the best ways we have of, like, manipulating anxiety within the lab. Now, one of the nice things about it as a neuroscientist is that you can do the exact same manipulation in a non-human animal model, right? So you can do the same thing to rats. You can do it to monkeys or whatever, which allows you to do slightly more complicated things and study different things than you would be able to in humans. So that allows you to actually get closer to understanding your neurobiology, because different animal models have certain relationships to human models and things like that. So we can actually, you know, better get closer to understanding what's happening in the anxious brain, as it were. But now we don't use shocks as a therapy. Far from it. We're using shocks to make people anxious, but only a little bit like it's not, you know, it's not awful, otherwise people wouldn't do our studies.
Iman Issa-Ismail [00:18:21] Are there certain demographics that are more at risk of developing psychological distress? And why is this.
Prof Oliver Robinson [00:18:28] Yes. So I mean, the thing to remember is that these are all general. So yes, there are certain demographics, but it's not to say that if you're within a certain demographic, you're definitely going to become depressed. And if you're not within that demographic, you're not going to become depressed. Right? It's all kind of broad now. Things like depression, anxiety, we know, are much more common in women, for example, than men. And when you look at the diagnoses now, that might be because the underlying neurobiology and the underlying vulnerability makes women more vulnerable. But equally, it could also be that because of society and the way we set things up, men are less likely to talk about their mental health and things like that. So but it's probably a bit of both. Generally speaking, you know, pretty much all psychiatric and mental health conditions are more likely in people, with difficult upbringings. Now, that might be for all sorts of reasons, you know, childhood trauma because of, you know, the family environment, but also minority status, like being an immigrant, being in an environment that, you know, is unfamiliar for you, like, all of these things can contribute to it. But it's sort of broadly speaking, any mental health problem is a combination of, you know, your underlying vulnerability and your, the environment that you're in. So you might have a really high vulnerability, because of your background or because of your underlying genetics, you know, for reasons that nobody really understands, you're more likely to become anxious, but because you're in a. Supportive environment. You don't then develop it. But equally, there are lots of people with a back, you know, completely supportive, normal, healthy environment that become extremely depressed. So with any of these things, it's kind of generalised. You know, gen generally, women are more likely to become anxious people with difficult upbringings, more like to become anxious and depressed. But it's not a kind of them.
Iman Issa-Ismail [00:20:21] So anyone can be a victim anyway.
Prof Oliver Robinson [00:20:22] Exactly, exactly. And, but but importantly, it's like trying to understand why those things happen. We know, for example, that like, a lot of mental health problems occur post partum. So like postnatal depression and things like that. So obviously that's only going to happen, generally speaking, to women who've given birth. But so that's one factor that might make, you know, women more likely to experience these things. And also just the impact to the social environment we live in. You know, we live in a patriarchy. ET cetera. Is going make things difficult for all. But all of these factors, it's a very complicated like, you know, intermixing of, of, of vulnerabilities and, the environment you're in basically. So, so we don't really know why people are more likely to become anxious, depressed, generally speaking. But there are these general kind of like, rules, as it were. Rules. Rules isn't the right word. That is general, risk factors.
Shakira Crawford [00:21:14] Okay. So anxiety yeah. Can affect anybody.
Prof Oliver Robinson [00:21:17] Yes.
Shakira Crawford [00:21:18] But I feel like in my personal experience growing up, I never suffered with anxiety. But as I've gotten older and I feel like everybody's just so much more aware of the surroundings and the so much more to be self-conscious of. I've become anxious in situations that I wouldn't normally. Yeah, care about. Yeah. So I don't know if it's a case of people being more anxious these days, or just the fact that our environment has just become so much more. There's just so much more pressure in the environment.
Prof Oliver Robinson [00:21:51] Yeah. So, so all of these factors are probably true. So I think that on the one hand there's a lot more awareness. So back in the day, you know stiff upper lip there's no such thing as anxiety. Right. People were probably anxious. They just didn't talk about it. Right. So that's definitely a contributing factor to people being more aware of it and being more willing to talk about it and being therefore, you know, recognising themselves. There's definitely a factor of, you know, as you get older, you accrue more experiences and, you know, you've been to being in a situation A, B, and C before and bad things happen. So therefore you're going to be wary of encountering that, whereas your child, you've never experienced A, B and C and therefore you're not anxious about it. So as you get a little bit older, you do start to accrue these these experiences actually anxiety and depression, like the, the earliest sort of age of onset is around the teens. So, you know, and that's a a period of massive social change. You know, it's when people go through puberty, they start to understand that they're part of a social environment. You know, when you when you're a child, everything's very simple, right? You know, there's you give given some rules and you have to worry about it once you're a teenager. Oh my God. Like all these hormones rushing, you've got to worry about stuff. So so definitely I think as people get older, it does increase. Now interestingly, with things like contacting depression, as you get even older, they start to decline. So as people are like, you know, elderly, actually they have the lowest rates of things like anxiety and depression. Now, that's not to say that there isn't like examples of depressed or anxious elderly people. Of course there are. But but it's, you know, as you get older, these things decline. But then there's also all these other factors, you know, we're much more connected world now. You know, hundreds of years ago, you might only know about what's happening in your immediate environs. Obviously, you're going to get anxious occasionally, but you're not worrying about a nuclear apocalypse, climate change, all of these factors, we're not, you know, 24/7 news cycle finding out about stuff all the time that all of this is probably contributing to people's anxiety. But again, it's a complicated picture. And we don't really know how much these things contribute and how much they don't. It seems intuitive that the more you find out about bad stuff happening in the world, the more action is going to be. But, you know, it's not clear that that leads to more anxiety disorders. It might make you still feel low level anxious, but but, you know, your experience is not uncommon. The thing I often say with anxiety and depression, like, yes, we have these diagnoses. Yes, we try to study them as like kind of single entities. But the reality is there's as different types of there's this many different types of anxiety, depression as there are human beings. You know what I mean? So any one person's experience isn't going to be the same as another person's experience. And and I think it's important, especially in the kind of clinical realm, to recognise what someone says. Like, I feel I feel like this is happening to me and that's totally true. That's your truth. That doesn't mean that's true for someone else or, you know, and everyone's experience is different. But yeah, so it's a bit of everything. Basically. Yes. Probably as you get older, you do get more anxious. Yes. Potentially. In this modern world, there are things that make people more anxious, but also that just might be your own personal trajectory, as it were, if that makes sense. All of the above can be true.
Iman Issa-Ismail [00:24:47] Is there any studies on women who tend to suffer more from anxiety because of like, hormonal? So like because obviously she's saying I obviously didn't notice as a young girl, but now she's grown up. She had. A child is more likely to feel so she's never experienced before.
Prof Oliver Robinson [00:25:02] Yeah, it's a good question. You know, it's actually not that well studied. But yeah, there are, you know, the where it's best study is in, like post child childbirth. You have these big hormonal changes. And we know that postpartum depression is a very big thing. So we know a little bit about that, but we don't really fully understand. I mean, the truth is, you know, we understand what anxiety is. When you ask someone, are you feeling anxious? And they tell you something that's we understand that, right? We understand a little bit about what's going on in the brain doing studies of electrical shocks and so forth. But really we're only scratching the surface, right? And, you know, hormones, neurotransmitters that your whole body is awash with all of these chemicals and they're all affecting lots of different things. And again, it affects person A differently to person B, so it's it's almost impossible task to try to fully understand exactly what's happening with, you know, this hormone in this woman in that moment. You know, maybe we'll get there down the line, but certainly that's probably one of the factors that contributes to women having higher incidence is probably, you know, hormonal differences because, you know, the sex differences in that. But we don't really fully understand it. There are people working on it. But, you know, it's it's it's not as well studied as it should be. Probably.
Iman Issa-Ismail [00:26:09] So how does, social media impact someone's mental health?
Prof Oliver Robinson [00:26:12] So the short answer is we have no idea. Right. And anyone telling you that we know that social media does X is just making it up, right? There is you know, it makes sense intuitively that being on social media 24 seven, which makes it easier for social interaction to occur, which therefore makes it easier for people to be bullied, makes it easier for people to pile on. Like it makes sense that that might make people feel unwell, right? But then there are also people for whom social media is literally their livelihood, right? Influencers and so forth. So you can't ignore one in the other, right? I think it might amplify certain social tendencies, right. The way that human beings, crowd around individuals and ideas and so forth might make some people more anxious, perhaps equally, might make other people less anxious depressed. So I think there is it, you know, personally, I don't like being on Twitter and things like that. I know it's not good for my mental health. There are other people who love it, right? So they say, okay, so speaking in generalised, generalised like statement saying, social media is causing an epidemic of anxiety. Is this something you hear people say, like there is actually no evidence for that. And I think with things like social media, it's going to bring good and bad. I mean, I remember that, Facebook, not on Facebook anymore, probably tells you what I think about social media. But I remember early on, you know, people thinking, oh, gosh, this is going to make people feel like you fear of missing out or whatever. I remember you on a Facebook. You realise actually nobody's doing anything fun. You know what I mean? Like early on it was like, just like, you know, you run a party once a week. I'm not missing out on anything. Right? So actually, early on, at least for me, Facebook actually made me feel less anxious because you like, oh, no one's doing anything good. Obviously, as they became more popular and you know that people could control their image and make their image crafted a bit more, but it looks like everyone's having these beautiful, wonderful time. Maybe that makes people more anxious. But the honest truth is that we just don't know. And for every argument that it might be making people worse, there are probably other people that it's making making them better. I think, as with anything in moderation, used carefully, you know, it probably it can probably help people. You know, people build careers on social media. Probably good for them. But yeah, we're only just beginning to understand how these how these things work.
Iman Issa-Ismail [00:28:13] Actually, funny, because a lot of people who build careers on social media talk about how they're anxious and have the social media's over, like, help them overcome it. So, yes, exactly. You know, just like a mixing pot of, like, different types of people. Yeah.
Prof Oliver Robinson [00:28:23] Which is true about everything, right? You know, as I say, everyone's different. This is made out of anxiety, depression are individuals. So some people it's good, some people it's bad. It just depends on how you deal with it and how you, how you use it. Exactly, exactly. You know, we do know that things like social media are good at, like, amplifying, you know, certain bad things, right? The way that engagement, you know, you get sort of hate speech and all that sort of stuff being amplified. That's clearly not a good thing. But, you know, that's not necessarily the same thing as causing mental health problems, as it were. So, yeah, as someone who doesn't really like social media very much, I'm reluctant to say that it's definitely causing anxiety and depression in people, even though it would be, you know, you know, it's an easy street. It probably is. But in some people it's not. So it's, you know.
Shakira Crawford [00:29:06] Yeah, because people tend to be a lot meaner on the internet because they have that shield of protection being anonymous.
Prof Oliver Robinson [00:29:12] Yeah. But then on the other hand, because it's a shield anonymous. If you're good at doing that, you can just say it doesn't matter because it's just, you know, just nonsense.
Iman Issa-Ismail [00:29:19] If you're on the receiving end, then it does matter.
Prof Oliver Robinson [00:29:20] Yeah yeah yeah yeah yeah yeah.
Shakira Crawford [00:29:22] Exactly. Yeah I tend to use social media mostly for in like inspirational quotes and stuff like Instagram shows.
Iman Issa-Ismail [00:29:28] Yeah, just simple stuff. I'm not trying to find the good part of. So. Yeah.
Prof Oliver Robinson [00:29:31] Yeah. Exactly. Yeah.
Shakira Crawford [00:29:32] Can build you up.
Prof Oliver Robinson [00:29:32] Yeah, yeah.
Shakira Crawford [00:29:33] The motivational challenge channels and stuff.
Prof Oliver Robinson [00:29:35] Yeah. Some some networks are better for that than others.
Iman Issa-Ismail [00:29:38] Maybe not Facebook, maybe more like. No. Yeah. Ideas that are more like this.
Prof Oliver Robinson [00:29:43] Yeah. Exactly.
Iman Issa-Ismail [00:29:44] This information.
Shakira Crawford [00:29:46] Why does it seem like anxiety affects a lot of adolescents more than anybody else?
Prof Oliver Robinson [00:29:52] I think it's because these problems emerge in adolescence. So you're a, you know, a happy smiley child. You become a teenager. You undergo adolescence. And that's when the. For the people who have the vulnerability. That's when it starts to emerge. And it's because adolescence is a period of massive social change, right? You start to form peer groups and you start to, you know, find who you're going to find attractive, attractive, all these sorts of things and all these hormonal changes occur. And with that, those big changes comes the precipitating factors that lead to things like anxiety and depression. It's definitely possible to become depressed later in life, for sure. But just often, you know, in general, it'll start to emerge for people who will emerge and later it will start to emerge when they're adolescents, just because it's a period of massive change, basically. And it may be, as you say, driven by the hormonal changes and so forth. But it's probably also just because of the way that adolescents behave in the social. You're starting to work out who you are as a human being. When you're adolescent, you're starting to branch out on your own. And yeah, and it's also a period of extreme of a lot more risk taking at the neuroscientific level. The way your brain works, you haven't quite got the control that you have as you, as you get older. And so adolescents are famously and take a lot of risks. Right. And, and with those risks can come, you know, bad outcomes, you know, start experimenting with drug use, for example, that might lead to more fact, you know, things down the line and so forth. So it emerges in adolescence. It's just a sort of known.
Iman Issa-Ismail [00:31:16] Known phenomenon off of that question. Sorry. Yeah. If you like, for example, a parent where you had anxiety, do you think that it's possible to see that you can impression your child in the same kind of like of your symptoms and the way you can that affect.
Prof Oliver Robinson [00:31:31] It's a very good question. So it's hard to tease these things apart, because one of the things we know is that, you know, genetics plays a strong role. So parents who are, more likely to be are depressed, their children are more likely to become depressed. So one argument you might say is, well, that's because the depressed parent is making the child, depressed. But actually it's not. It's just that you both have the same underlying vulnerability. That's, that's that's leading to that. We just don't really know, to be honest. Like, there is an argument to be made that certain types of behaviours are more likely to make you actually depressed and, you know, certain types of parenting behaviours might. But anyone telling you that they know that that's what's happening, you know, other than, other than like trauma, like, you know, series of abuse as a child is clearly going to lead you to become, you know, is much more likely to lead to problems. And again, not always, but beyond that kind of more lower level stuff, it's just not clear, really. Yeah. You can make an argument both ways.
Shakira Crawford [00:32:26] Basically. Yeah. Adolescence is a period of a lot of change, of where you become like independent and it's a lot of like body changes, a lot of environmental changes and stuff. You know, something that you said that I found very interesting was you said during Covid and the lockdown, anxiety was.
Prof Oliver Robinson [00:32:43] This is I think this is a good cautionary tale for why when someone tells you X leads to Y, right? So if someone says social media leads to people being more anxious, you should be cautious, right? Because although that might sound obvious, it might not be true. So a good example of this was during Covid. You had lots of people saying Covid is making people more anxious. Obviously it makes sense. You know, you've got a global pandemic, you might die. That's how we felt early on. Like if you go outside, you might die. That's going to make people more anxious, right? But we happened to have some longitudinal studies running where we studied people before Covid, and we'd ask them about how anxious, how depressed they were. And just because we'd been running the studies we needed to collect the new data. We collected some of that data during the pandemic. Right. And actually, we showed that in some of our samples, anxiety actually went down right during the pandemic, like in the real thick of it, where we weren't leaving our houses. So that although obvious to a talking head on TV, Covid makes people anxious, right? Unless you've actually done the research, you don't know for sure that that's true. And actually, one of the reasons I think with anxiety is that it depends on the type of anxiety you have. Right? We talked earlier about social anxiety. If you're socially anxious and now you're allowed to leave the house, well, that's a relief, right? I don't have to talk to people. Right? I choose when to talk to people. Right. So I think with any of these things, it's, it's, it's, it's a that's a good example of where simplistic messages, you actually have to do the work to see. And no one's, you know, there are people working on the relationship, for example, between social media and mental health. But, you know, the story might be much more complicated than it seems at first glance, if that makes sense. And obviously for some people, Covid was terrible, right? You know, it's not to say that Covid was great for everyone's mental health. It's just to say that there are certain people for whom it was actually, you know, for a short period time anyway, was actually helpful for them. It's just that the, you know, everything's complex and everything interacts in complicated ways. And mental health, going back to the point I keep making over and over again, it depends on the individual and you know, what your environment is, what your circumstances are, how you react to certain things.
Iman Issa-Ismail [00:34:35] So on the topic of social media, are there any apps or websites that you would recommend people looking for support or information regarding mental health?
Prof Oliver Robinson [00:34:43] So I would say be very, very careful. I would generally say go to the NHS websites, go to your GP. If you're worried about your mental health, there are, you know, private therapists you can access. But I would always start with seeing your GP. The reason for this. It's a wild West. There are lots of apps out there claiming they can do X, Y, z. I've worked with some of these companies. And I know that the evidence base just isn't there for some most of these things. And you've got to be very careful about, you know, if someone's really anxious, really depressed and having them do something that's not helpful, it's not a good idea to always talk to a health care provider. There are digital app based solutions that do work, but they will almost always be accessed through a health care provider. They won't be something you can Google. Essentially Google it in a sense is not ideal because you can find all sorts of terrible stuff out there. Having said that, again, whatever gets you through the day, right? So if you find that, certain types of soothing music or whatever, it helps with your anxiety, that's brilliant. Go for it. Right. But if you're really, really feeling unwell, if you're really anxious, really depressed, or you know someone, that is because oftentimes people don't necessarily recognise it that much in themselves or they're not, you know, especially when you're depressed, you just might not want to do anything. It's important that you get them to see a health care provider.
Iman Issa-Ismail [00:36:09] Yeah. Which is following that question. If you are a person who's anxious and find it hard to call the doctors. Yeah. What would you suggest? Because you can't.
Prof Oliver Robinson [00:36:16] Well, that's a good question. I mean, yeah, that's a really good question. I would say, there are websites. So if you go to the NHS website, there is, there will be advice there that you can do without talking to somebody. There are things like NHS one, one one, there are phone lines, mental health. If you go to charities like this charity mind, they're like they have resources for people that don't necessarily involve seeing a health care provider. They might have Drop-In sessions. They might have places you can go. Like half the battle with mental health is recognising that there's an issue and trying to do something about it. And often for many people, just that process of trying to do something about it is all they need. You know, that gets them out of the house and that helps them. But it is it is a challenge. And, you know, the other thing to be honest about is the mental health care provision we have is, is good for those who are able to get into the system. But the waiting lists for things like sexual psychological therapy are just too long. You know, that's not really my area, but that's something we need to fix down the line. But, unfortunately, there aren't any quick fixes. You know, you might be able to find the I mean, I'm not I don't want to give you the idea that you can download the map. It's actually bad for you. But if someone's really, really anxious and depressed, like, it's it's probably not gonna be very helpful.
Iman Issa-Ismail [00:37:29] Well, there are, like, meditating apps. Yeah. What's the. I used to have, like, mood calm or something. You had, like, specific breathing. I was on the. Have you seen the storm? The orange thing. And it's like, breathe in, breathe out headspace.
Prof Oliver Robinson [00:37:40] So, so so this is. Yeah, this is actually these apps have aspects of one of the types of therapy called mindfulness therapy. It's basically kind of like eastern philosophy packaged as a mental health treatment. Which actually, again, can work really well for some people. The problem is it actually works. It doesn't work for others. Right? So some people mindfulness is actually actively harmful. So, you know, some of the aspects of mindfulness are like sit there and allow the thoughts to happen in some people. That's actually makes them worse. In some people it helps. Right. This is why I think it's important to work with a health care provider, because they know all the different options available to you. So there's a whole other set of therapies called cognitive behavioural therapy. In many aspects, they're almost the opposite of how mindfulness works. Both of them are successful in some individuals we don't know who respond to which. But like, but you know, you don't want to try something. It not work and then be like, well, there's nothing for me because there are many options out there. But yes, if something like meditation, guided meditation through the headspace app, for example, is helpful for you, then that's brilliant. But I don't want people to get the idea that there's a quick fix here, that you download an app and you solve stuff. And I also don't want people to think that if that doesn't work for them, that therapy doesn't work for them, or that, you know, treatment. And with him and again, in some people, medication is the only thing that will work for them in about 25% of people, something like that. So there's no app you're going to, you know, download. It's going to help you. You need to see a clinician and get prescribed something. Again, it depends on the individual. But I'd be very hesitant to say when we talk about extreme anxiety and depression, like depression, like clinical aviation, there's no way that's probably going to help you really on its own.
Shakira Crawford [00:39:09] What are some common misconceptions or stereotypes about mental health?
Prof Oliver Robinson [00:39:13] I mean, stigma is a big one. It's getting better. It's not as bad as it used to be, but the idea that, you know, if you're anxious, you're depressed, you're weak, or you know that it's it's all it's all in your head, you know? Sure. It is all in your head, in your body, your feelings, anxiety and depression. But that doesn't mean it's not a thing, you know, just because it isn't something that you can ascribe to, like some specific physical cause, like, you know, broken leg is a broken bone. It's not in your head, it's a broken bone. Mental health problems, in a sense, are all in your head because that's what mental health is. That doesn't make it less bad than a broken bone. If anything actually makes it more complicated in the broken bone, because we don't really understand our heads or our psychology. Very much so. Yeah. The biggest misconception, I think, is that the. It's some sort of sign of weakness. Or be that because. Because it's sort of in your head, it therefore, you know, it's not a real thing and you can sort of get over it, as it were. I think those are the two, two biggest misconceptions.
Iman Issa-Ismail [00:40:10] So how helpful would you say is therapy for anxiety and what other options are available for those who are suffering?
Prof Oliver Robinson [00:40:16] So for some people, therapy is perfect. It solves all the problems, right? That's probably about half, maybe a little bit lower. Then we know this from from, like treatment services. If you get into a treatment service, about 50% of people show some kind of improvement. They might not get completely better, but they'll get some sort of improvement. So about half of people, some kind of therapy and there are lots of different flavours of therapy will work for them. In terms. But that means that for half of people they won't work. Right. And what that means is that, like if you engage in therapy and it doesn't work for you, you're going to be spending a lot of time with a therapist, maybe a lot of money if you're doing it privately. And it doesn't help. Right. So that's, you know, for the people it helps is great. For people. It doesn't help. It doesn't it's not great. And it can lead people to be frustrated with the system. Right. Other treatments we have are, medication. Now, there's really, one main class of medication which is selective serotonin reuptake inhibitors. That's the sort of primary treatment. These are also known as antidepressants. Prozac. You know, they're all kind of the same thing. That works for maybe a quarter to a third of people, some of whom are the people who the therapy doesn't work for. Okay. But again, a large number of people, the medications do not work. There are some other types of medication you might be prescribed. Pregabalin. There are things like, very fast acting things, that, call benzodiazepines, which you might be prescribed very, very short period of time. They're very addictive. So you can't use them chronically, but you can use them, you know, in a, in a for a very short period of time. It can make people very, you know, much less anxious. But that's basically all we have. We have a few medications and we have a few different classes of therapy. There is still a subset of people. This is why I still do this. There still is a group of people, maybe about a quarter, maybe about a third, for whom nothing we have works. Absolutely nothing. Right. And this is why it's not good enough. The situation we have, why I study what I study, because I don't think we're going to be able to close that gap without fully understanding how the brain leads to things like anxiety and depression. But critically, going back to the point to earlier, talk to your GP, your GP will be able to funnel you into different avenues of treatment, whether it be medication, whether it be psychological therapy. And the key thing is to know is that you don't know in advance whether you respond to one or the other, and certain people might not want to take medication, certain people might not want to do therapy, but that doesn't necessarily mean that they will or won't work for you. And the important thing is to know that as it stands now, it's going to take a while, right? You might get lucky. And the first thing you try works for so brilliant. But for most people, it's a trial and error process of trying different things. It doesn't work and and nothing is without side effects. The medications have side effects. The therapy has side effects. And so it's really important that you, you know, you work with someone who's trained in this to try and find, what works for you.
Shakira Crawford [00:43:02] What are some useful coping methods and techniques you can do to help yourself if you're struggling with anxiety?
Prof Oliver Robinson [00:43:07] So I'll go back to my point again. If you're really struggling, go see a health care provider. Right. But, you know, if it's the sort of mild level anxiety that's not really getting in the way too much, but it's bothering you. Yes, you can try different techniques. So there are therapy based techniques. So mindfulness based techniques might help you. Things like meditation, things like calming music and so forth. There are specific, like, tools. You can get a book about cognitive behavioural therapy and read about how that works, about reframing situations, things like that. You can do a bit of research into that. Again, it's better with both of these to see a therapist. But again, if it's low level, maybe you might be able to read about this and help you out. Help yourself out. Exercise is an excellent help form for lots of people, right? Not for everyone, but getting out there, even if it's just a short walk or if it's going for a run. I know myself like I need to run, you know, multiple days a week. Otherwise I start to feel really anxious and really depressed. I feel lots of energy build up my body. That's not for everyone. But again, that's a sort of technique that might help, help you. But whatever works for you really is the answer. In many, many cases, just the simple thought of, oh, I'm a bit anxious and recognising it might actually help you. That might be all you need. But but basically, if you're really, really unwell, go see a doctor goes up and, and, there's no substitute for getting actual, like, clinical help.
Shakira Crawford [00:44:32] You know, if you're in an anxious situation trying to take your mind off of what's causing the anxiousness could help.
Prof Oliver Robinson [00:44:38] Yeah, but that might work for some people. Doesn't work for other people. So some people saying, right, don't think about the thing that might help you, other people, it really doesn't help them at all. And so that's, that's the difference in one case. That's one the difference between mindfulness. Mindfulness might be like let it wash over you. And, in other kinds of cognitive approaches, it might be like try and think about something different or. Frame it in a different way. These tools, you just have to work out for yourself. Generally with the help of someone who trained what works for you and what doesn't work for you. If you're lucky, you can kind of work it out for yourself. But but it's, you know, it's it's if you're really active and depressed, if there's no substitute for someone who knows you've seen it lots. And then this is the thing to remember. It's probably a good point to end on, is that it's very common. Right? And so when you see a therapist, you it will not be their first rodeo. Right. When you have these feelings, it can feel like you are the only person in the world that suffers from this. You're the only person who has these crazy ideas, these crazy thoughts. You are not right. You know, that's not to say that it's not important. Obviously, it's really important, but it is to say that there are people who day in, day out work with this and are able to help. So yeah, that would be my sort of take home message. You are not alone. Speak to somebody.
Shakira Crawford [00:45:53] Okay. Thank you so much, Doctor Oliver Robinson, for meeting us today. It's been so informative to talk to you.
Iman Issa-Ismail [00:46:00] So thank you for joining us on our final episode. Thank you for all our special guests that we've had. And thank you for watching all of you people.
Shakira Crawford [00:46:08] And a big thank you to UCL and future Formed for making this podcast happen. Big thank you to Iman for being my co-host, wonderful co-host.
Iman Issa-Ismail [00:46:15] And care for being an amazing producer.
Shakira Crawford [00:46:18] And once again, thank you, Doctor Oliver Robinson for joining us.