Research roundup: technology and anxiety

A summary of articles looking at the latest research on how social media, blogs and apps are impacting mental health.

Technology is omnipresent in today’s society. According to Internet Live Stats, 88.5 percent of the U.S. population uses the internet and, according to the Pew Research Center, 95 percent of Americans own cellphones and 77 percent own smartphones. How is this technology impacting our lives? The answer may depend on how we are using it. Technology can be useful in finding information and connecting us with friends and relatives. But if we get too absorbed into the constant flow of messages, news and updates, technology could become a potential source of stress and anxiety.

The following research summaries examine technology and anxiety from two different angles: how technology impacts our lives and how it is being used to provide clinical intervention. Psychologists are encouraged to explore the literature more completely to determine what may be useful to them in practice.

Vannucci, A., Flannery, K.M., & Ohannessian, C.M. (2017). Social media use and anxiety in emerging adults. Journal of Affective Disorders, 207, 163-166. http://dx.doi.org/10.1016/j.jad.2016.08.040.

This study sought to examine whether there is a relationship between social media use and anxiety in a large U.S. sample (n=563) of young adults (18-22 years, Mage= 20). The study recruited participants through a web-based market research company. Participants completed online self-report questionnaires — a Technology Use Questionnaire that examines use of eight social media platforms; the Beck Anxiety Inventory-Trait questionnaire to assess anxiety symptoms; and the Overall Anxiety Severity and Impairment Scale that measures anxiety frequency, severity and impairment. Participants, on average, spent more than six hours a day on social media. Men spent more time than women (M= 7.41 and M=5.86, respectively). Social media use was not significantly impacted by age, race/ethnicity or educational status. The researchers found that higher daily social media use was associated with more anxiety symptoms, but was not significantly associated with any anxiety-related impairment. Because the results are correlational, the researchers can only speculate why higher social media use was associated with some anxiety symptoms. It is possible that social media could produce anxiety because of negative feedback or cyber-bullying, pressure to constantly update content, downward social comparison, or information overload. Alternatively, perhaps anxious emerging adults seek out social media in an attempt to feel better about themselves through online validation from others or to communicate without actual in-person interaction. Social media may be beneficial to young adults as a source of social support during a developmental period when anxiety can be prevalent.

Trub, L. (2016). A portrait of the self in the digital age: Attachment, splitting and self-concealment in online and offline self-presentations. Psychoanalytic Psychology, Advance Online Publication. http://dx.doi.org/10.1037/pap0000123.

Attachment theory is used to examine how people with different attachment styles represent themselves online and offline. The researcher looked at blogging, a form of online expression with some degree of anonymity, by individuals with different attachment styles to see if they explore parts of their identity online that they may not explore in their offline lives. Participants (N=145, 62 percent female, 73 percent white, mean age 37.8 years, 70 percent college-educated and employed) were recruited from a pool of active bloggers. Participants completed the Experiences of Close Relationships scale. They also identified two sets of three adjectives — one set that people who know the participant might use to describe them, and another set that their blog readers might use to describe them. The researcher compared the adjectives along three dimensions: positive/negative, self-concealing/self-revealing and other-focused/self-focused. For securely attached individuals, the adjectives of their online and offline audiences were the same or similar on positive/negative and self-revealing/self-concealing dimensions. In contrast, fearful-avoidant individuals used significantly more negative and self-revealing adjectives for the assessment made by their online audience than by their offline audience. When compared to securely attached individuals, those with high avoidance or anxiety were three times more likely to be self-revealing online than offline. Also, securely attached individuals were significantly more likely to be self-focused online and other-focused offline.

Mohr, D.C., Tomasino, K.N., Lattie, E.G., Palac, H.L., Kwasny, M.J., Weigardt, K., . . . Schueller, S.M. (2017). IntelliCare: An eclectic, skills-based app suite for the treatment of depression and anxiety. Journal of Medical Internet Research, 19(1), 1-14. http://dx.doi.org/10.2196/jmir.6645.

This study sought to determine whether a suite of smart phone apps that teaches brief skill-building techniques from diverse theoretical orientations, together with minimal, low-effort coaching could change participants’ scores on anxiety and depression scales and whether this type of interactive app with coaching would promote app use. Participants were recruited through HealthPartners, a Minnesota-based health care system, online advertising and clinical research registries (n=99, median age=36, 76 percent female, 24 percent male). Participants met the criteria for Major Depressive Disorder or Generalized Anxiety Disorder (based upon a depressive symptoms score greater or equal to 10 on Patient Health Questionnaire-9 [PHQ-9] or an anxiety symptoms score greater or equal to 8 on Generalized Anxiety Disorder-7 [GAD-7]). Individuals were excluded from participation if they had a condition or circumstance that could prevent smart phone use or met diagnostic criteria for severe psychiatric disorder.  

For eight weeks, participants were asked to choose from a selection of 13 apps — and encouraged to try one new app a week and follow the app’s instructions. Participants received an initial informational phone call with a coach and a follow-up call at four weeks. Coaches sent two or more texts per week to participants to provide support and encouragement and answer questions. Participants completed PHQ-9 and GAD-7 measures at baseline, four and eight weeks; researchers also monitored their app use. At the end of eight weeks, for depressed participants, 37 percent met criteria for full remission or no symptoms, 40 percent met criteria for recovery or mild symptoms, and 22 percent met criteria for further treatment. For anxious participants, 42 percent met criteria for full remission or no symptoms, 45 percent met criteria for recovery or mild symptoms, and 14 percent met criteria for further treatment. Participants showed strong and sustained app usage across the study with an average of 195 total app launches per participant.

Clinical implications

Technology has the capacity to be a clinically useful treatment tool. Given the ubiquity of social media use, the opportunity for online expression through blogs and other strategies, and the prevalence of apps, identifying technology’s pros and cons for individuals in the context of treating mental and behavioral health concerns could be an important objective.

Given the positive association between social media use and anxiety that was found in the Vannucci study, psychologists may want to assess for social media use when assessing anxiety, especially in adolescents and emerging adults. Social media could be both a coping strategy as well as a trigger for anxiety, so considering the negative and positive aspects of social media use with patients will be important. And, depending on the individual’s use of social media, particular applications to treatment may be relevant whether it be promoting the possibility for connection or addressing some of the maladaptive behaviors, such as the tendency to engage in downward social comparisons when using social media.

Blogging may be another clinically useful technology mode, as explored in the Trub study. Fearful-avoidant individuals might be able to engage in identity growth by sharing personal information and vulnerability in a space where they have some control to an audience that can offer validation, feedback and acceptance. Blogging may also provide an opportunity for securely attached individuals to take a break from their other-focused offline lives and spend time exploring their own interests.

Finally, apps that are well-designed and evidence-based may be an attractive way to deliver mental health care to those who do not have access to or choose not to access more traditional mental health services. Similarly, apps could provide a low level “step” of care for individuals. Facilitating the selection of an appropriate app with some limited coaching may enable psychologists to help a greater number of individuals and address some of the barriers common to traditional treatment.

More information on apps is available in these two articles (The New World of Apps [PDF, 349KB] and Benefits and Risks of Apps [PDF, 96KB]) in Good Practice magazine and PracticeUpdate.

Information on technology and stress is available in APA’s newly released Stress in America report on the Stress in America Press Room page along with resources for clients and patients on managing stress.