Smartphone

Digital Media and Inattention Symptoms

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

While there are many positive benefits of media consumption, excessive consumption can have negative consequences.

The average American consumer spends about 4.9 hours per day watching TV, 75 minutes per day on their smartphone and 62 minutes per day listening to radio (1). Many people spend most of their workday working on a computer.

TV and video gaming has been associated with adhd and related symptoms in a review of studies from 1987 to 2011 (2).

A recent study looked at many forms of digital media usage and adhd type symptoms (2).

Who was involved in the study? (3)

  • 4100 students ages 15 and 16 years were followed for 2 years.
  • Starting baseline and every 6 months, they were given surveys on digital media usage, inattention and hyperactivity.

How did the study define digital media (3)?

In this study digital media usage included using a variety of devices for social media, smart phone usage, streaming media, web browsing, messaging/video chatting, etc.

How did they define frequency of digital media usage? (3)

High-frequency (many times per day) vs other frequency levels (0, 1-2 times per week, 1-2 times per day).

What were the results? (3)

  • Among students with no adhd symptoms to begin with, those who used digital media at high frequency were more as likely to report symptoms of inattention and hyperactivity compared to those use rarely used digital media.
  • The most common high frequency media activity reported was checking social media.
  • Over 2 years of  follow up, the students who reported no high-frequency media use at baseline were half as likely to have ADHD symptoms across follow-ups vs students who reported 14 high-frequency activities.

What are some caveats?

  • This is a large study of young adults followed over 2 years.
  • They looked at many participants with little or no adhd symptoms to begin with.
  • While this study shows an association between digital media usage and adhd symptoms, it does not necessarily show that one causes the other.
  • This study was done on adolescents, which limits applicability of results to other age groups.
  • Further study is needed.

What are some negative consequences of excessive screen time?

Excessive screen time can (4):

  • Worse executive functioning
  • Increase aggressive behavior due to violent media content
  • Elevate depression risk
  • Decrease sleep quality.

Some individuals may also spend less time sleeping because of screen usage; which can worsen daytime fatigue and productivity.

Other studies show that screen time can also worsen the physical health of adults in many different ways.

Oftentimes, excessive media consumption can take time away from other self-care activities.

Are there some useful ideas around media usage?

American Academy of Pediatrics guidelines on media use for children and adolescents advise to (6,7):

  • Prioritize activities that promote executive functioning and well-being, including
    • Sleep
    • Physical activity
    • Distraction-free homework
    • And positive interactions with family and friends.
  • Encourages discussions about pro-social uses of media, digital citizenship, misinformation, and persuasion awareness—are relevant to the cognitive and emotional reactions to digital media of adolescents.

Consider periodic breaks, and rules around how often and how much media you consume electively.

  • Consider limiting elective screen-time to less than 2 hours per day (5).  Focus on quality instead of quantity.
  • Some people find it useful to use a timer.
  • There are apps that can help you limit excessive screen time.
  • For other tips, go here
  • In some cases excessive media consumption may be a red flag for mental health concerns.

Any other thoughts on media consumption?

  • While there are no specific guidelines for adults, if most of your day studying or working in front of a screen, choosing to spend leisurely time spent on other electronic devices, phones, tablets etc. may not balance your life or your brain.  It may lead to increased stress and fatigue.
  • How much time are you spending on electronic devices? Is this making you productive or just busy?
  • How do you feeling during and afterwards?
  • How is this impacting your mental health, physical health, productivity, academics ?
  • Have you set limits on elective media consumption and should you cut back?
  • Should you be doing other activities to balance your life; such as sleep, exercise, cooking nutritious food, spending quality time with others, etc. ?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. https://www.statista.com/topics/1536/media-use/
  2. Nikkelen  SW, Valkenburg  PM, Huizinga  M, Bushman  BJ.  Media use and ADHD-related behaviors in children and adolescents: a meta-analysis.  Dev Psychol. 2014;50(9):2228-2241. doi:10.1037/a0037318
  3. Ra CK, Cho J, Stone MD, et al. Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA. 2018;320(3):255–263. doi:10.1001/jama.2018.8931
  4. Reid Chassiakos Y., Radesky J., Christakis D., et al: Children and Adolescents and Digital Media. Elk Grove Village (IL): The American Academy of Pediatrics, 2016.
  5. https://www.nhlbi.nih.gov/health/educational/wecan/reduce-screen-time/index.htm
  6. Radesky J. Digital Media and Symptoms of Attention-Deficit/Hyperactivity Disorder in Adolescents. JAMA.2018;320(3):1–2. doi:10.1001/jama.2018.8932
  7. Media Use in School-Aged Children and Adolescents. COUNCIL ON COMMUNICATIONS AND MEDIA. Pediatrics Oct 2016, e20162592; DOI: 10.1542/peds.2016-2592

Smartphone Apps for Mental Health

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Most people today are familiar with apps for smartphones.  There are apps for many different purposes including mental health. In fact in 2015, mental health apps made up almost a third of disease specific apps in app marketplaces (1).

Some but not all apps are evidence based, researched, and known to work and some other apps are based on evidence based skills.

A 2017 meta review of studies looked at 190 individual papers researching 147 unique digital health tools and found that there may be some benefit of using apps for depression and anxiety but unclear benefit for other disorders at the time of publication. They also found research and method limitations for many studies (2).

A recent study looked at an app called “Virtual hope box” (VHB) (3).

Who was studied? (3)

  • 118 U.S. service veterans receiving mental health treatment and had a recent history of suicidal ideation.
  • They were divided into two groups.
  • One group received mental health treatment as usual supplemented with the VHB app and another group received treatment as usual supplemented with printed materials about coping with suicidality over a 12-week period.

What was measured? (3)

Using validated scales, the study authors measured coping, suicidal ideation, reasons for living, perceived stress and interpersonal needs at various points of the study.

What were the results? (3)

  • Participants using virtual hope box app showed improvements in their ability to cope with unpleasant emotions and thoughts over time.
  • Users found the app helpful for relaxation and distraction or inspiration when feeling distressed, when emotions were overwhelming, or when they felt like hurting themselves.
  • Participants found it easy to use, helpful in dealing with stress and emotional difficulties, likely to use in the future, and would recommended to others.

What are some caveats?

  • This is a small study and may not be applicable to everyone.
  • There are many apps for mental health but research in this area is limited.
  • Newer apps are being introduced frequently.
  • This is a new field of research, and as we learn more, study designs and outcome measures are being improved upon.
  • Not all the apps are free.
  • Mental health apps do not take place of professional treatment.
  • Your mental health professional may be helpful in considering the right app mental health for you.
  • There are many apps that use evidence based techniques such as apps for cognitive behavior therapy, relaxation skills, prolonged exposure, dialectical behavior therapy, mindfulness based apps, etc.
    • One such example is the OSUCCS app, which can be obtained from the app store.

How much time are you spending on your phone? How are apps in general impacting your mental health? Which app is helping you and which is not?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. IMS Institute for Healthcare Informatics. (2015). Patient adoption of mHealth: Use, evidence and remaining barriers to mainstream acceptance. Parsippany, NJ: IMS Institute for Healthcare Informatics.
  2. Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C. and Davies, E. B. (2017), Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta-review. J Child Psychol Psychiatr, 58: 474–503. doi:10.1111/jcpp.12663
  3. Nigel E. Bush, Ph.D., Derek J. Smolenski, Ph.D., Lauren M. Denneson, Ph.D., Holly B. Williams, B.A., Elissa K. Thomas, L.P.N., C.C.R.C., Steven K. Dobscha, M.D. A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress.  Psychiatric Services 2017; 68:330–336; doi: 10.1176/appi.ps.201600283.

Smartphone use before bedtime might impact sleep, and daytime tiredness

Smartphone or cellphones are a useful tool and when used properly can have many benefits.
Many students frequently use cell-phones and often very close to bedtime. Students may not know that cellphone use might impact their ability to sleep at night and this might impact their daytime energy levels.
This study explored the relationship between cellphone use at bedtime and sleep.

Who was studied?
532 students aged 18–39 were recruited from lectures or via e-mail (1).
Mean time of media use per night was 46.6 minutes.

What were the study results?
Mobile phone usage for playing/surfing/texting was positively associated with insomnia.
Computer usage for playing/surfing/reading was positively associated with insomnia.

What do the results mean?
Computer or cellphone use in bed before bedtime may worsen your sleep.

How does screen time impact sleep?
There are various potential causes:
Media use might make it take longer to fall asleep (2).
Media use might mean less time spent sleeping, thus reducing sleep (3).
Bright light emitted by electronic devices might impact sleep quality (4).

Light exposure might be temporarily activating you (5-6).

Are you sleeping poorly? Are you tired during the day? Is screen time before bed impacting your sleep? Will cutting down on screen time improve your sleep? How do you know?

By R. Ryan S Patel DO, FAPA, OSU-CCS Psychiatrist
Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References
1. Fossum IN, et al. The Association Between Use of Electronic Media in Bed Before Going to Sleep and Insomnia Symptoms, Daytime Sleepiness, Morningness, and Chronotype. Behavioral Sleep Medicine. Volume 12, Issue 5, 2014, pages 343- 357. Published online: 14 Jul 2014. DOI: 10.1080/15402002.2013.819468.

2. Higuchi, S., Motohashi, Y., Liu, Y., & Maeda, A. (2005). Effects of playing a computer game using a bright display on presleep physiological variables, sleep latency, slow wave sleep and REM sleep. Journal of Sleep Research, 14, 267–273.
3. Van den Bulck, J. (2004). Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children. Sleep, 27, 101–104.
4. Cain, N., & Gradisar, M. (2010). Electronic media use and sleep in school-aged children and adolescents: A review. Sleep Medicine, 11, 735–742.
5. Cajochen, C., et al. (2011). Evening exposure to a light-emitting diodes (LED)-backlit computer screen affects circadian physiology and cognitive performance. Journal of Applied Physiology, 110, 1432–1438.
6. Campbell, S. S., et al. (1995). Light treatment for sleep disorders: Consensus report. III. Alerting and activating effects. Journal of Biological Rhythms, 10, 129–132.