When I came across mental health startup Joyable in the form of a Facebook ad, I was intrigued. It promised to address social anxiety using Cognitive Behavioral Therapy (CBT). CBT is a type of talk therapy that trains a patient to examine their feelings of anxiety and focus on the causes of those feelings, in order to better cope with them.
Based on my non-expert-college-psych-minor opinion, I had more than average social anxiety. I wanted to try it out. But I also had questions.
Why did I seem like a good target for a social anxiety advertisement? Who decided I seem like the type of person to experience high levels of stress in certain social situations? Can my Facebook friends tell? Why does only 1 out of my 768 Facebook friends "Like" Joyable?
The ad from Joyable provided a free quiz to (hopefully) quell my fears. The SPIN (Social Phobia Index) quiz asked questions around fear of authority, speaking around others, if you're afraid of blushing, and other questions relating to feelings and behaviors relating to social anxiety. (You can take the quiz here.)
I questioned my results. I must've fat-fingered too many answers incorrectly. But maybe I was making up excuses for accurate responses that correctly described my acute social anxiety.
At the least, I could work towards trying stand-up comedy. I already had an open mic place in mind that I'd attended previously without performing, partially due to arriving late, but mostly due to an overwhelming amount of anxiety. Reflecting on this situation, it was clear I could benefit from some type of intervention.
I signed up for Joyable, intending to only use their weeklong free trial, avoiding the $99 per month fee.
The program consists of guided learning and activities, an online community, and conversations with a coach from time to time to check in on progress, reflect on activities, and address upcoming situations that may induce social anxiety.
I selected preferences for my coach based on personality traits you're looking for. Aside from these traits, you can also select gender. I opted for female, as I (embarrassingly) cannot imagine opening up as much to a male confidante.
I received an email from a client coach. Bethesda*, or Beth**, wanted to chat through the Joyable program, discuss my goals, and set expectations for what I'd possibly get out of the program.
*name has been changed for privacy
**name has been changed again for abbreviation
I was under no illusion that I was getting medical advice: The Joyable site notes, and Beth restated, you are not speaking with a licensed medical professional or therapist.
We got on a call where Beth introduced the concept of CBT and explained the structure of the Joyable program. I was expected to complete an activity on the website every other day, but Beth encouraged me to take my time. The "coursework" seemed very light, which made sense to me. You probably don't want to give someone with anxiety a lot of work with a tight deadline.
We talked about her background before Joyable; she previously worked in support and counseling-type roles. Beth remained open after I explained my intention to write about my experience with Joyable.
We also spoke about my goal to try stand-up comedy. Through my CBT lessons, I realized I'd been practicing avoidance behaviors in my previous attempt to stand-up, as well as other social situations in my life. These are ways, sometimes not consciously, that you exit or avoid situations that you know will cause social anxiety. For me, that meant thinking I was unprepared once I go to the open mic. The reality was I'd never be fully prepared, and just needed to do it. Unconsciously, it meant taking my sweet time getting to the open mic, so I'd miss the sign-up.
A few days into my Joyable trial, I went to an open mic for stand-up. This experience involves going to the back of a Thai restaurant (your mileage may vary), waiting for an hour for the sign-up list to be available, signing up, then waiting for 15 other guys to do their three minute sets before I could make my debut. I'd been warned that a light would go on in the back of the room when you had one minute left. For some performers, this light was like a memory eraser. They'd see the light, and their train of thought was instantly derailed, and they'd end their set abruptly. I worried this would happen to me.
I met a fellow performer who introduced himself after he heard it was my first night up. It was his first time as well. I asked him why today was the day he decided to give it a shot. I also wanted to ask him if it was wise to have a beer and a plate of Thai food prior to performing, but I just figured he had a stronger stomach and less anxiety than I.
He said he'd posted something on the stand-up comedy subreddit—apparently, he just said he liked a certain comedian—and someone commented "go kill yourself." He noted this made him feel like he had to give stand-up a shot himself, to spite this commenter. I didn't completely understand the connection, but still deeply respected a guy taking IRL action to spite an anonymous jerk who'd never know about it.
As I debriefed with Beth, the anticipatory anxiety waiting to perform greatly outweighed the fear I felt while on stage. I'm sure I did look stupid and wasn't very funny, but the performance did not cause me nearly as much pain or embarrassment than I anticipated. The one minute warning light didn't erase my memory, like the pen from Men In Black. I realized I had been catastrophizing, imagining the open mic experience to be unanesthetized brain surgery, when it was really just a needle prick.
Conversation with Practicing Mental Health Professional
I was finding the Joyable experience to be effective, but wasn't sure what was the placebo effect, what was science, and what was nonsense. So I got on the phone with Dr. Sarah Sullivan-Singh, a clinical psychologist who uses CBT-type therapies in both clinical and research settings.
The approach Dr. Sullivan Singh uses is called Acceptance and Commitment Therapy (ACT). ACT doesn't try to challenge or change thoughts as in traditional CBT. Instead, you have a different relationship with thoughts. "You can recognize thoughts are productions of your mind," Dr. Singh noted, which I took to be a very Buddhist approach.
Traditional CBT, as Dr. Singh described, is more around cognitive restructuring: completing thought records, looking at automatic thoughts that come up spontaneously, looking at the evidence whether this is true/false, then develop a thought that is ideally more true to reality.
I expected her to mirror my original skepticism with an even heavier and critical eye. She was not familiar with Joyable, so I caught her up to speed with the program.
Dr. Sullivan-Singh mentioned that the most powerful intervention for social anxiety is often exposure, which Joyable encouraged through both speaking with the Joyable coach, and recommended exposure through real life social situations. I selfishly didn't think of those with a higher degree of social anxiety than mine. Dr. Sullivan-Singh mentioned that in-person meetings with a therapist can be an overwhelming first step for those with severe social anxiety. Online activities and phone calls would be a great first step.
In my conversation with Dr. Sullivan-Singh, I realized CBT exercises to be similar to weightlifting: you can only get stronger by slightly tearing what you already have. She agreed this was a terrific analogy.
The presence of social anxiety makes sense in the context of evolution, Dr. Sullivan-Singh said. In the days of tribes hunting and gathering, she explained, "being kicked out of a tribe meant death." So we inherently have something pushing us to care what others think. But when the anxiety is no longer a survival tool, and it prevents one from thriving, interventions should be made.
In terms of Joyable, she said this could be a great service for people who need an intermediate step before setting foot in an in-person therapy session with a professional.
She noted her concern to screen out individuals who need more intensive professional help. I confirmed with Beth, aside from the online checklists for users to self-select, there are internal procedures to ensure cases are escalated by client coaches if needed.
"Psychotherapy is way more expensive than an app on your phone," Dr. Sullivan-Singh noted, and this was a great way to get the science of academics into the hands of more people. "The mechanics don't really matter as long as it's working."
Interviewing for a Job
During my trial, I'd entered into a perfect storm of anxiety-inducing situations. Aside from finally trying stand-up comedy, I made it to the final round of interviews for a new job I'd applied to in San Francisco. I requested to speak with Beth prior to interview day. We discussed my anxious thoughts, such as "I'm afraid I won't know the answer," or "They will be grossed out by my sweaty hands."
Beth asked what I would do if a friend approached me with these anxieties. How would I calm them down? It was simple, but proved to be extremely effective exercise in perspective. I realized I can greatly weigh the objective weight of a situation by placing someone else in it. Beth apologized it would not be possible to lessen the hand perspiration, but may be an outcome later on.
Through the interview, I felt relatively calm, and much more aware of my thoughts. It was a process lasting about three hours, with multiple interviewers. I felt confident and relaxed, though hand perspiration was still present.
Beth texted me to see how the interview went. I thanked her for her advice, and we shared excitement in the fact I'd been offered the job.
She emailed me an article about moving to the Bay Area, even after stating I planned on canceling my account.I told Beth the most noticeable impact was inventory of the thoughts in my head that caused anxiety, and if they were really worth the mental real estate they inhabit. Many times, for me, they were not.
It was great to have someone who I considered a CBT expert to help me learn strategies for coping with anxiety and celebrate in small successes. I couldn't imagine doing this with a friend. For me, talking to stranger allowed me to open up much more. Perhaps this is the same reason I actively post on Twitter but have such a light Facebook footprint.
At first, I thought of Joyable as some fluffy life guide nonsense that only those with too much disposable income would use. But it was much more practical, and I found it extremely helpful in exploring new social situations such as an open mic, but also things I'd done before, like job interviews.
At $99/month, It's more expensive than a Netflix account, but cheaper than traditional therapy sessions. (It is worth repeating that Joyable cannot replace traditional therapy for many people, depending on their mental health history, severity of their anxiety, and other factors.)
I went over my free trial period, using the service for two more weeks before cancelling. I rationalized this as a mental health "gym membership." To understand, or at least attempt to identify the root causes of my social anxiety, has been an extremely useful exercise that I'll continue to use. I think of Joyable as the ski lesson you can opt to take before hitting the mountain (of social anxiety) if you want some guidance on how to navigate it.
Between my discussions with Dr. Sullivan Singh and the Joyable program, I came across a finding that will stay with me: We often overestimate the likelihood something bad is going to happen, while also underestimating how well we can cope with it. It may seem like common sense, and it is. But for some people, like me, it was worth paying for a reminder.
Ashwin Rodrigues is a writer who recently moved to the Bay area. He also makes tweets.