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Social Media and Serious Mental Illness: The Good, ...
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Hello and welcome. I'm Tristan Grindow, Deputy Medical Director and Director of Education for the American Psychiatric Association. I'm so pleased that you are joining us for today's SMI Advisor webinar, Social Media and Serious Mental Illness, the good, the bad, and the unknown. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Now, I'd like to introduce you to the faculty for today's webinar, Dr. John Torres. Dr. Torres is a member of SMI Advisor's Clinical Expert Team and is the Director of Digital Psychiatry Division in the Department of Psychiatry at Beth Israel Deaconess Medical Center, a Harvard Medical School-affiliated teaching hospital, where he serves as a staff psychiatrist and academic faculty. John is board certified in both psychiatry and clinical informatics. John, thank you so much for leading today's webinar. We're very excited to hear from you. Thank you, Dr. Grindle, and thank you all for tuning in, or if you're watching this, for logging in. So, before we start, I want to mention a disclosure. We're running a study using a digital medicine that's not related to today's talk. That study is funded by Otsuka, but not related to this talk. To get to what we're going to talk about today is really about what is social media happening? What is happening in social media? How is that impacting our patients? What do we know? What do we not know? What can we do? I think if you type into Google News, read any newspaper, you're seeing almost every day there's headlines, screen time is bad for mental health, screen time is helping mental health. It impacts sleep. It doesn't impact sleep. In this talk, the learning objectives are we're going to try to be able to explain to patients how they can access social media, how they can monitor what they're doing, and how we can explain what are some of the risks, and what are some of the benefits. Look for what are some of the warning signs about too much social media, when is logging on screen time too much, and how could that be impacting health, and recognize and know when to apply at least three different treatment strategies to help patients reduce social media use in a safe manner. The outline again is we're going to talk briefly about social media and SMI today. It's a large, large topic. We're just going to try to understand what people are using, how much people are using. Then we're going to look at some of the benefits of social media and SMI, and say how could this be helping people? We're next going to explore the risk and say, hey, what are some of the things that could be less helpful? We'll spend more time on the unknowns, and we'll talk about both the risks and benefits in the unknown section. We'll briefly talk about what are treatment plans, what are strategies, what are things that you could be doing today in the clinic around talking about social media. To get us started, I think the question is how big is social media? Who is using this? Clearly, numbers are always changing. These are numbers from a website, statistica.com. You can see that as of January 2019, Facebook has basically 2.2 billion users. If you say how big is that, the US is about 2.3 billion acres. Imagine that gives you some context of how big that number is. You can see YouTube is the second most popular social media network, WhatsApp, and then you see Facebook Messenger, WeChat, which is larger in Asia, Instagram, QQ is actually a social network product more in Asia, it's not seen as much in the US. The idea is I think what you may have noticed from patients, from children, from colleagues is certainly these social networks are large and very prevalent. The question is, what are people with schizophrenia? Are they also using these social networks? Are they partaking in this? What I want to talk about on this slide is some smaller studies, but that gives you an idea of what people with schizophrenia may be doing with social media. On the left side of your screen, there's an interesting study that came out in 2017, but it was based on 2012 data. You can see that even in 2012, so seven years ago, 68% of people with schizophrenia who in this survey study said they were using social media at least once a day. A more recent study from 2015 surveyed people in a community clinic and looked at who was using social media, and what they found, Facebook was the most prevalent at 39%. Currently, people are on it, and the survey Google+, which is going away, was popular. This was older, so MySpace was still there, Twitter, Instagram. I think there's certainly no contraindication to using social media if you have schizophrenia, and I think clinical experience also says that patients are there. This was a study that we did with NAMI, Ken Duckworth, the senior author is the medical director for NAMI. It was a self-reported survey study that we published in 2016, and we were asking people with schizophrenia, what are you doing with technology? How much time do you self-report you spend? You can see that the number three was on social networking sites, spending perhaps an average of two hours per day. Again, we'll talk later in the talk, now we can get more precise measurements than just self-report. Again, we're seeing this evidence emerging that people with schizophrenia are certainly using social media and interested in it. What are some of the potential benefits if a patient comes and talks about what are some of the things and reasons they may be using it, some of the things they may be gaining? This is a very interesting survey study also that was done in youth mental health, so not schizophrenia, and it was done by Hope Lab, and it was basically they asked teens from age 14 to 22 years old, tell us about your technology use in relation to mental health. You can see from the bar graph, 87% had gone online for health information, 64% had used a mobile app related to health, 61% had watched someone else's health story online, 39% had looked for similar concerns online, only 20% had connected to a health provider online. You're getting the sense there that not everyone may want to connect to a health provider online, but people are going to learn experiences and stories. This is a quote from the report, you can access that report free at the link below that says, I searched for people on YouTube that were posting about their disorder, and it helped me understand that I need to tell my mother about mine, a 17-year-old female. The graph in yellow is very interesting because what it shows is people who self-reported higher symptoms related to depression, they were actually using the internet more to find information, so the darker yellow, again, it's 90% who had moderate to severe depressive symptoms were going online to look for health information, and we see now 75% were reading or watching someone else's health story online. You can see that people who may have more symptoms, who may want help, are actually turning to, in some ways, these technology internet resources more, and that brings up the question of what can these tools do, and there's some very fascinating research by Danielle Schlosinger. This is research she did when she was at UCSF, she's now at Verily, which is a company related to Google doing health, but she made this fascinating app called PRIME, it stands for Personalized Real-Time Intervention for Motivation Enhancement, and the paper is free to read, you can download it, but in essence, they built an app that offered a social network that was designed for people with schizophrenia, it was designed to connect people to peers, it was designed to connect to therapists. You can get a sense from the screenshot, it helped you learn about goals, it helped you share moments, and this was the first study they had, a feasibility study, and it says the results from this study demonstrate that the app, again, PRIME, is a feasible and acceptable intervention for young people with schizophrenia, over 70%, again, it was a small study, n equals 20, of our participants reported owning a smartphone and 95% reported using social media, so this was an interesting app, and they actually did a very interesting follow-up study, so that was done in 2016, it was published, and this summer, in June 2018, they did a study where they had 22 people use this PRIME app, again, Personalized Real-Time Intervention for Motivation Enhancement, and 21 people were in the treatment-as-usual or weightless control group, it was a 12-week study, and they gave people, again, the app, and they say improvements in our primary outcomes, they compared weightless control condition to people using PRIME, and they were able to show that people using the app had an increase in their expenditure of effort to increase likelihood of interaction, and increase anticipated pleasure on the modified trust task, so there were some positive outcomes really targeting negative symptoms in schizophrenia, and certainly, I said, it's a small sample size, the authors also noted, the interesting thing is, people who got better using the app, there wasn't a dose response, so some people who logged on to this kind of app social network every day who were engaged, they got positive outcomes, some people who were less active or maybe logged in once or several times, not as much, also got better, so some interesting questions about what is the mechanism of action, what does dose mean in terms of kind of using a social network to improve outcomes in SMI conditions like schizophrenia, so certainly very exciting research and very innovative research, and I know that Daniel Flosinger and her team are certainly continuing to work on PRIME, so I think this brings up the point of what is the role of social networks and certainly neural networks in SMI, and especially schizophrenia, this was a paper that my mentor and I, Michiri Keshavan, worked on, and what we were describing, and really this figure explains it, is certainly that we know that in schizophrenia, there's altered neural networks that can be responsible for negative symptoms and can be responsible for cognitive and social cognitive deficits in schizophrenia, and we know that certainly genetic and environmental factors have an impact, and we know certainly patients who have more negative symptoms, who have more social cognitive deficits, they do have smaller social networks, so we're not talking offline social networks, we're talking social networks of people that they socialize with when you actually look at their real-world social networks, because of negative symptoms and cognitive social deficits, there are these smaller social networks, and they're definitely related to functional disability. There's even been research showing that smaller social networks are related to these neuroanatomical changes. You can actually have ventricle enlargement if you look at neuroimaging studies for people who have smaller social networks, so the interesting question now is if there are these smaller in-person social networks, and they're related to functional disability, what is the role of social media to kind of come in and augment or boost these social networks? And we don't have an answer today, but I think it's a useful model to just look at this and kind of realize that perhaps social media may fit in where we see those social network reductions. Is this going to be a way to boost social networks in a way that will increase function in people, which is what we really care about the most? And I think this brings up to the point of relationships matter a lot. In the same study we did with NAMI, we were asking people about not only technology, but the importance of relationships in helping deal with schizophrenia, and you can see that most people found relationships are very, very important. Of course, there are different relationships, mental health care professionals, spouses, partners, parents, health care professionals, friends, siblings, but the point is being relationships are very important, and if social media can strengthen or augment those relationships that people are having, that's going to lead to better outcomes. So I think some of the benefits of social media will be establishing new relationships, maintaining relationships and reconnecting with people, and online peer support. We'll talk about this a little bit later on in the unknown section because there's a lot that we're learning about it, but certainly I think we can't say that social media is all bad. Screen time is always harmful. I think there are certainly some important use cases here, and these may be things that you could almost check out a list and check for your patient if they're using social media. Is it to establish new relationships again to kind of expand their network, to maintain their network, or kind of actually be finding support? And I think an interesting application of it for maybe around exercise, and this was a paper that was led by Joe Feer, who was at Manchester at the time, and he was looking at exercise, and his question was, what are the motivating factors and barrier towards exercise in SMI? And if you look at the motivating factors slide, you can see that the number one reason people would want to exercise is to improve their physical health. But if you look, there's something, the lowest one down there, there's kind of one little thing that doesn't quite fit the trend, and it's social aspects. That seems to be the least motivating factor for people with SMI, and it's about maybe 28%. So you can imagine that there's a role if people have perhaps more social support or social aspects, that could actually be something helping people exercise, or it's certainly concerning that that's the least motivating factor. It's something that potentially could be improved. If you look at the barriers to exercise that we present, the second greatest barrier is lack of support. So you can imagine, in some ways, these increased social networks, increased social support really could be a key to helping people get more physical activity and getting more steps. So this is something we'll be covering in future webinars is the role of technology and exercise, but certainly an interesting application, just unique how social aspects really sticks out as different from the trend. But of course, we need to be balanced and talk about benefits and risks. So I think the point being, what are things that we would be concerned about or that we perhaps should be looking about? What are some of the warning signs that you may want to consider if patients are using social media? So we're going to talk a little bit about screen time, and then we're going to talk about a recent study that came out in 2019 that perhaps put screen time in new context. But this was one large study, again, looking at just over 40,000 people, a national sample, two to 17 years old in the U.S. And what they're showing is more than one hour of screen time a day is associated with worse psychological well-being. And the key is associated, that symbol. And they said, high use, seven hours a day, those people are two times as likely to ever have been diagnosed with depression. And if you look at these graphs taken from the paper, if you look at the one that's a little bit more complex, you can see that what they're showing is people who are spending, say, seven hours have a higher association of being on a medication for depression or being in treatment. And certainly there's no cutoff right now of what is too much or too little social media. I think we could all probably agree seven hours a day is excessive. And so certainly that's the extreme end of it. But the point being there may be an association. Again, associations do not imply cause and effect. Associations cannot apply. It's not causal. But there are certainly, I think these studies are coming out a lot. This is an older one that was looking at a national survey of almost 2,000 young adults looking at different social networks from Facebook, YouTube, Twitter, Instagram, Snapchat, and said people who are using a lot of different platforms at the same time had a higher, again, risk or association with depression and anxiety. But I think the question that begs is, is that causal? What is that actually telling us? And that said, I think we're beginning to learn that some healthcare systems are saying, well, even though we have this kind of only association, we don't know the cause, too much screen time is concerning. This was a headline from the UK, the national health system is launching its first internet addiction clinic. The center in London will focus on gaming disorders with plans to expand. And that was from June 22nd, 2018. So certainly there's some concern around this. And to also look at kind of the risks is not all content on social media is good. We previously talked about, well, there could be benefits from peer support, from learning about illnesses. This happened just over a month ago. The headline is Instagram banned suicidal or self-harm related content after outrage following death of a 14 year old UK girl. And again, this person's death, which sparked international outrage against Instagram was linked to graphic content that she was posting and apparently consuming on the platform. So this was a family was very advocating for this, but certainly we're seeing that there's changes happening in real time about what content can be shared and what can't be shared. And is there kind of a contagion effect that people are watching kind of content related to self-harm is that leading to self-harm, but as of February 20th, 2019, this year, Instagram is seeking to cut back on it. And I think one of the risks certainly may be also there can be stigmatizing content as well. And I think we certainly are all working to minimize stigma. We know that stigma does exist in SMI and certainly the internet is a place where stigma has migrated to some extent. This was a study within 2015 where we compared on Twitter, the words kind of hashtags, schizophrenia or schizophrenic, which is a more stigmatizing word for diabetic and diabetes. And we want to see how are people using these hashtags on Twitter. And you can just see that people are using diabetes less negatively of less sarcasm and less inappropriateness. So certainly I think anyone going online has to probably in this day and age expect that they're going to be exposed to some content that certainly is stigmatizing. That said, this content can certainly be recorded. Increasingly, there's ways to flag it, record it and get it removed, but it certainly does exist there. And there's negative content. I think certainly some people may say this is a risk, some a benefit. We learned on January 1st that Facebook is monitoring content that you may type into Facebook for information about suicide or using natural language processing. And if you're typing something and your words triggered an algorithm to have say high risk of suicide, perhaps you're typing words about overdoses, about dying. It may trigger an algorithm that will have a human review it. And then Facebook will call the local law enforcement to conduct a safety check and come out to your house. So this happened in my state in Massachusetts around in Cape Cod that the police were called by someone at Facebook to say, go do a safety check. I wasn't part of that, but from reading the story, apparently the suicide had unfortunately already happened. So it just tells us that the Facebook algorithm isn't yet correct. And I think what's concerning certainly is a lot of people may not realize, it's very hard to actually tell from reading Facebook's terms and conditions that this is happening, that by using social media, that by engaging on Facebook, you're actually being monitored for suicide risk by Facebook and they may be sending the police or an ambulance out to your house to do a safety check. Because Facebook is a private company, they don't have to share this data and these results with us. But I think certainly something that people should at least be aware of and understand what it is. I believe the only way to opt out of this is to not use Facebook. I don't think they've set a way that you can opt out of kind of being monitored for suicide risk. Another headline that came out again very recently, February 19th, was the FTC, sort of federal government, accused Facebook of revealing sensitive health data in groups. So certainly I think realizing that information you type into social media may not stay private for very long. And I think the Facebook health groups, now there's kind of this back and forth of what's that information on social media meant to be private, if it was a health group or not. Certainly in the suicide screening story, that was information you'd be kind of typing on your wall or updating your status. But realizing that social media isn't going to afford the protections that all of us kind of may expect under HIPAA or various forms. And so I think we've now kind of looked at some broad benefits. We've looked at some concerns or some broad harms, mainly around how much screen time is too much. But I think the truth is it's more of a mixed picture. We're learning as this evolves, as you saw a lot of the headlines and stories were really from a couple of weeks ago, many of them. So this is a topic that is evolving in real time. And to go back to looking at stigmatizing content and what is actually being shared, say on Twitter around mental health, for World Mental Health Day in 2017, there was a pretty popular hashtag called My Tips for Mental Health, where people from around the world were sharing their tips for mental health. So they were kind of saying, and we categorized our research and we said, is the kind of message that you're putting, is it off topic? Is it stigmatizing? Is it resource related? That may mean I go to NAMI website and find stuff there. Was it a personal tip saying when I feel more depressed, I do this, or was it a medical or clinical tip, something around medications or was it inspirational? You can get an idea from the bar graphs, those pink bar graphs that people were sharing a lot of personal tips or inspirational content or some resource. Unfortunately, there was some stigmatizing content. But if you look at the graph that kind of shows retweets and favorites, you get to sense, you can see the stigmatizing content may have been a smaller number. It was only 853 versus almost 6,000 personal tips, but that stigmatizing content was getting retweeted. It was getting noticed or kind of moved around a little bit. And not as much as some of the other categories, but you can almost see the mixed picture here. We have different types of content, some good, some bad, and both of them are kind of existing. And some of the stigmatizing content is getting pushed forward. It is getting retweeted. It's moving through the social network. So again, it's possible to flag this content and have services like Twitter, and they will remove it and take it down. But the point being, there's gonna be good content and there's more good content, but that bad content is still gonna be there. I think a related issue is, going back to our survey study of people with schizophrenia and how they use technology, is when people may be in a crisis, are they gonna wanna use technology to communicate with people? And you can see that blue is when feeling well and orange is when experiencing many symptoms. So certainly when some people are not feeling well with schizophrenia, according to this study, they may not want to reach out and be using technology as much. You can see it's more when they're feeling well. So you can almost be saying this is more towards prevention. And when people have more symptoms, perhaps they don't want to be using this as much. So if we're designing these systems or social networks to help people when they want help the most, we don't know fully yet, but there's some concern is this when they may not be accessing them. We saw before in the Hope Lab survey of youth with depressive symptoms, they were people who had higher depressive symptoms were looking for information. And so again, you can begin to see the mixed picture of when are people accessing these services? What do they want? And when do they want it? What's also interesting looking at again, our survey study for schizophrenia is what is actual, what do people think of these services when they've actually used it versus when they perceived they'd use it? So certainly many people are on Facebook. Some people have Twitter, some people are using different social networks, but are people's opinions based on what they've actually used it, their experiences or kind of perception of it. And it seems that when we kind of stratified the results by people who had used it and people who hadn't used it, their kind of thing, what I think it would be useful to start the internet, what I think social network sites would be, the perception was 2.4 is lower and it went up to 5.3 people that actually used it. So it seems that people that actually logged on and use the social networking sites did find them more helpful. That centers almost everyone using technology did find it more helpful, but it's a pretty big jump. I said, there are big jumps in all our data, but going from 2.4 to 5.3. I'm sorry, I'll click advance to the next slide. I think this may be one of the most interesting slides that really shows the mixed feelings game. We asked people, what are the positive feelings you get from using technology including social media? What are the negative feelings? And you can see that positive one out around 75%, but there are also negative feelings, 56%. And the number one kind of positive when we broke it down was people felt more connected and they felt happy, inspired, hopeful, peaceful, motivated, empowered. These are things that people are saying I'm gaining from it. On the negative side was unable to stop, frustrated, paranoid, worried, sad, angry, manic and envious. So again, certainly a mixed picture. And we did dive into paranoid and actually looked at the literature site. Is social, are people actually say getting worsening of certain psychotic symptoms? Is social media worsening, hallucinations? And the evidence for that is pretty minimal at this point. There are some case reports, but it's hard. It's actually, it really would fall into an unknown bucket. But I think the big picture is it's a mixed picture. There's some benefits like most things and there's some risks. I think the unable to stop we'll get to soon, but does point to something to check with people. How much time are they spending? Are the patients you're working with, if they really are spending, say seven hours a day, again, we only have association sites, but that may be an interesting issue. Going back to that Hope Lab site, it looked at youth who are using social media. There was one question that said, does social media kind of make you feel better, worse or neither? And almost 50% said neither, they are neutral. About 22% said it makes us feel worse. And 30% said better. So again, kind of a mixed picture. And what I really wanna focus on is this slide. This was a paper that came out in January, 2019 in Nature of Human Behavior. And it's a very important study. You may have seen it in the news. It went around for a couple of weeks. And what the author said is they said, look, we have all these cross-sectional studies that assess people at a single point in time. They say, tell us about your social media use. Tell us about your SMI symptoms. Tell us about other things in your life. And we're gonna get all these questions, all this cross-sectional data. And what would happen is, again, so let's say we have people fill a survey on social media use and SMI symptoms. We then draw an association between the two. And the authors of this paper said, there's always bias in a cross-sectional study because how are you gonna do the analysis to link the two things? Which variables are you gonna include or not gonna include? Which will you weight or which will you not weight? So what the authors of this paper did is they took data from a lot of cross-sectional studies, almost 300,000, and they used a method called specification curve analysis. We don't have to worry about what that is. But the point is they found 6 million ways to analyze this survey data, 6 million. So they basically said, let's run every analysis possible. Let's do every combination of self-reported symptoms. And they said, this way, because we're gonna run all 6 million ways to weight all the different parts of social media, of different symptoms, of exercise, of diet, of sleep. If we run, again, these 6 million analyses, we'll get out different values of the social media health or hurt. And what you're seeing on this graph is kind of the result of running millions of analysis. And what you can see is the point is, on the far right, you're seeing, depending how you cut the number, sometimes there's a benefit. Red is where there's really neutral. And the negative numbers are maybe when social media is causing harm. And the point of the study was to say, we can learn a lot from cross-sectional studies, but there's a bias in looking at a snapshot at one point in time. And depending on how, again, you cut the numbers, you can say that social media is, one, helping, two, neutral, or three, not helping. And the authors of this study say, we think that social media is associated with 0.4% of adolescent well-being is related to screen use. And the quote that I thought was pretty funny in the paper, they say, 0.4% of kind of adolescent well-being, again, related to screen use, has the same impact as eating potatoes on a regular basis. And so the authors of this paper are saying, when you average all the different ways you can analyze the data, maybe social media isn't having this impact on adolescent well-being related to mental health. This is not directly SMI, but I think the message is very powerful. So next time that you see a survey that says, screen time is related to this and bipolar, internet log-ons are related to this and schizophrenia, you wanna remember that's cross-sectional data, and it certainly has value. We've, our group has done many studies like that, we continue to, but there's always, it's hard to actually know what is the ground truth. And this study really said, look, it could be up, it could be neutral, it could be down, but the average seems to be neutral. Certainly though, if you have a patient who's spending seven hours a day on social media, that may be certainly something to take into note. So I think we're not basing clinical judgment off this, but we're just saying, hey, we have to be careful when we're interpreting these studies. So I think that brings up the issue of, what can we do with social media when patients come to us? If patients are asking about it, what is the role of it in clinical visits? And I think what you can probably tell is just from talking about the benefits, the risks and the unknowns is, it's hard to say with certainty because one, this is still evolving. As you saw that Instagram changed its policies around self-harm content just over a month ago, and we really don't have a lot of data. A lot of data we have are these cross-sectional survey studies. A lot of them haven't been done specifically in SMI. Some have, but they're small. So there's still a lot that we're learning. But I think one thing that I've certainly noticed clinically and there's been interesting papers on is YouTube is a very popular social network, especially among people with schizophrenia. And there was an interesting paper by John Naslund, who was at Dartmouth at the time he wrote it. And it says, the reciprocal exchange between YouTube commenters in response to content upload by individuals who self-identify as having SMI represents a dynamic, responsive, yet informal system of peer support. So it's a very interesting paper where they kind of look at how people are self-identifying and kind of explaining their symptoms, their experience with SMI, what they've learned, how they're coping with the illness. And there's some very dynamic, very positive exchanges. What happens certainly, some of you may have noticed in the fall, there was an interesting article in the Atlantic Monthly that noticed that some of these YouTube videos that were talking about mental health were actually being sponsored by teletherapy companies who weren't disclosing it. So it's interesting to kind of see the realm of advertising kind of come into perhaps what was this kind of dynamic community of more peer support. So imagine that you have a YouTube channel, you've been talking about mental health, and all of a sudden you start talking about this great online therapy. And again, what the Atlantic article uncovered was actually what kind of state paid or sponsored spots. And after this was uncovered, and after this was uncovered, it was kind of people apologize. But the point being, YouTube is not a medical, the content there may be useful for some people, but again, we can't guarantee the content's going to be right. We can't guarantee it's actually gonna be covertly sponsored by people. But I think there is a lot of positive content that people find, and there's a lot of positive exchanges. So this was a just interesting study that was done up looking by Steve Bartel's group up at Dartmouth looking at technology among people offering peer support, and really showing that again, peer support agencies, they're embracing technology, they're using smartphones, they're on social media. And this paper is arguing this is a really useful platform, social media, to further extend the reach and impact of peer support. This is a way that kind of we can activate the wonderful work of the peer community and kind of take it even further. I think we talked about earlier today around kind of how much screen time is too much, and we said we don't really have an answer. One interesting feature, if anyone has updated their smartphone, be it an Apple one or Google one since summer, you may see this feature pop up in your phone that tells you about how much screen time you had. And it's an interesting feature because it really counts pretty exactly how much time you had your phone open. It's not gonna tell you about your computer time, but you actually can ask a patient, you can ask someone to show it to you, and you can actually get a sense of how many hours a week, how many hours a day are people spending, and it actually will tell you how much time was spent on each individual app. So if you wanna know how much time was spent on Facebook and Instagram, that actually can be tracked and monitored. You can set limits on it, and you can say, well, how much time was spent on maybe Facebook compared to a exercise app or say a symptom tracker. So you don't actually have to rely on self-report anymore and say, do you feel like you're spending too much time on these social media platforms? While this only captures smartphone data, a lot of social media is now accessed via a smartphone. One number I've heard is up to 80% of kind of being on social media really is done via smartphone. So this actually may be a very accurate, easy way that you can partner with someone in clinical business and say, hey, let's understand how much time you have on the screen, or let's get a sense of it if it's something that you're worried about. So you can now collect this data very easily. If you've updated your phone, it's auto-installed. The data is being collected anyway by the phone. So there's nothing you have to install. You're just asking someone to show it to you on the phone. In some ways, treatment planning can be hard. And the reason it can be hard around kind of understanding social media is we don't yet really understand the mechanism of action of what's happening. And this figure is meant to say, if someone's coming in and they're having symptoms related perhaps to social media, you almost wanna wonder three things with colored boxes. Is excessive social media use or spending too much time, is this a new representation of an existing construct? Is someone who had anxiety now kind of using Facebook or Twitter or kind of, is anxiety kind of being manifested now through social media online? Is someone who's liable to addictions, are those same triggers now kind of being triggered by the social media platforms designed to keep engagement? The other buck in the middle is, are kind of symptoms of someone's having related to changes in behavior? Is it because you're spending more time on social media, there's changes in rewards, there's changes in sleep or impulse control? There's a lot of research sometimes going back and forth saying sleep and social media, it impacts and it doesn't impact how well you handle. There's not much research, but some early research saying, are there changes in neurocircuitry related to using social media? It's too early to tell. But you can imagine each of these three buckets are very different things to consider, especially the behavior existing construct. And because we don't have the longitudinal studies, we have limited sample sizes, it's really hard to actually know how to categorize what these are. Because again, is it a comorbidity? Is it a single condition? Is it a spectrum of condition? So it's actually very hard to recommend and say we should be using CBT, we should be using novel treatments, we should be using those. So I think the most important thing that you may think about when seeing a patient who you're worried about excess of social media is one, you can now check on their smartphone what the actual use is. But you may think, is this more related to behaviors that are being changed through social media? Or is this related to kind of perhaps something else going on, a underlying anxiety, underlying addiction? And that may be a useful step. There are different scales around technology use, internet addiction. None of them have really been validated specifically in SMI. A lot of them focus on feelings of lack of control around internet use, ensuring psychological, social or professional conflict, and mental preoccupation or failure. So a lot of these scales around excessive internet or technology use are very similar to ones you already use in your treatment around substance abuse. And I said, certainly there are some classic ones like Young's Internet Addiction Test that have really stood the test of time even before smartphones. What's interesting is sometimes these different scales, there's one by Tao at diagnostic criteria actually developed and they exclude patients with say bipolar or psychotic disorders. So again, we don't have great scales around how people with SMI are using these. But I think one thing that clinically you certainly want to consider is you really can track and learn about the time people are spending on this by asking people to show you that screen, the screen time feature of their phone. That will actually give you some objective numbers to learn about very easily. And if you're worried about excessive social media, you can almost think about tapering may be an interesting way to go. If you think about it, this is perhaps related to an underlying, say anxiety disorder. When you stop something like that, it can just increase. If you go cold turkey, it may just kind of increased underlying anxiety and kind of lead to going back and using more. So it makes sense to likely if you want someone to be using less to try to reduce and taper, but really it's replacing connect. When we started the benefit of these social networks are likely to connect people to really help them build new networks and new connections. So if someone is using social media at the point you think is excessive, it really is saying what can we replace us with? What are new connections we can do? But again, treatment planning is in part difficult because this is an evolving space that we're still learning about and we don't have all of the details. So I wanna thank you guys for listening.
Video Summary
In this video, Dr. John Torres discusses the impact of social media on individuals with serious mental illness (SMI). He highlights the benefits and risks associated with social media use and explores the unknown aspects of its impact on mental health. Dr. Torres emphasizes the need for clinicians to understand social media and its potential effects on patients in order to provide appropriate care.<br /><br />He explains that social media can provide a platform for peer support and the sharing of experiences, which can be beneficial for individuals with SMI. However, he also highlights the negative aspects, such as excessive screen time, stigmatizing content, and potential risks to privacy and mental well-being.<br /><br />Dr. Torres discusses the current research on social media use and mental health, highlighting the limitations of cross-sectional studies and the need for further investigation. He also suggests using tools like smartphone screen time tracking to monitor and manage excessive social media use.<br /><br />In terms of treatment planning, Dr. Torres advises clinicians to consider individual patient needs and potential underlying issues, such as anxiety or addiction, when addressing social media use. He suggests a gradual reduction in social media use and the importance of fostering alternative connections and networks.<br /><br />Please note that this summary is based on the content of the video and may not fully capture all the details and nuances.
Keywords
social media impact
serious mental illness
peer support
mental health
clinicians
screen time tracking
treatment planning
alternative connections
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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