Help I’m Alive is about being paralyzed by the expectations of others (like peers or audiences, but Haines’s own expectations of herself as well) and the anxiety those expectations bring on.

Frontwoman Emily Haines discussed this track with Drowned in Sound:

This song is the first of many that I wrote on the piano during my time in Buenos Aires. It started out as a ballad but really came to life once we bumped up the tempo. My favorite part of the song is the kick drum sound in the middle section, it sounds like the drums are being played in a cathedral in hell."

Shaw told Rhapsody:

I imagine our songs as people. “Help I’m Alive” punched “Gimme Sympathy” in the face and jumped in front of it. We had this image of me coming into the studio one day and the back door was wide open and there were only nine singles there, and “Help I’m Alive” had run out and was streaking down the neighborhood."

Acoustic Version

A few weeks after the song’s initial release, an acoustic version – with Shaw on acoustic guitar and Haines on piano – was released as a single.

This has been featured on the TV shows One Tree Hill (episode: “Believe Me, I’m Lying,” 2009), The Vampire Diaries (episode: “The Night of the Comet,” 2009), 90210 (episode: “Age of Inheritance,” 2010), and Grey’s Anatomy (episode: “If Only You Were Lonely,” 2012).

This peaked at #21 on the band’s home chart, the Canadian Hot 100. It was also their first track to break into the US charts, where it landed at #17 on the Alternative Songs chart and #30 on the Rock Songs chart.