Latest / The Antisocial Doctors Podcast / Episode 20: Are We Addicted To Social Media?

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Episode 20: Are We Addicted To Social Media? · The Antisocial Doctors Podcast

1:27
Sonia Singh MD: You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
1:38
Rebecca Berens MD: and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
1:43
Sonia Singh MD: We're also a millennial women anxious moms and curious humans navigating social media.
1:48
Sonia Singh MD: We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
1:56
Rebecca Berens MD: This podcast is meant to be the antidote to your doom.
1:58
Rebecca Berens MD: Scrolling, a, solve for the anxiety, stress, guilt, shame, and confusion.
2:02
Rebecca Berens MD: That comes from social media's messaging around health.
2:05
Rebecca Berens MD: In each episode, we discuss a health related topic, trending on social media with curiosity, nuance, evidence, humility, and compassion.
2:12
Sonia Singh MD: This is not your average debunking podcast.
2:14
Sonia Singh MD: We wanna explore not just what is trending on social media, but why?
2:18
Sonia Singh MD: Why are so many people drawn to this?
2:20
Sonia Singh MD: What is the nugget of truth here?
2:21
Sonia Singh MD: What are the facts?
2:23
Sonia Singh MD: What can we learn from this as patients and doctors?
2:25
Sonia Singh MD: No shame.
2:26
Sonia Singh MD: No blame, no snark.
2:27
Rebecca Berens MD: We're so glad you're here.
2:42
Sonia Singh MD: All right.
2:42
Sonia Singh MD: Hi, Rebecca.
2:43
Rebecca Berens MD: Hi, Sonya.
2:44
Sonia Singh MD: I feel like I should start this episode by being like.
2:46
Sonia Singh MD: Hi, Rebecca, I'm Sonya, and I am a social media addict.
2:50
Sonia Singh MD: 'cause I feel like that is what I learned when I was researching for this episode.
2:56
Sonia Singh MD: Instead of a patient story I'm gonna share with you not one of my patient story, but a patient story that came from a landmark trial which was KGM versus meta etal, which you may have seen in the news.
3:08
Sonia Singh MD: So basically the case was that a 20-year-old, currently 20-year-old woman, but I think she was 17 at the time that she brought this case in California, sued multiple social media platforms alleging that the platforms were intentionally designed to be addictive with features like infinite scroll, autoplay, algorithmic recommendations, notifications, and that these resulted in anxiety, depression, and body dysmorphia for her.
3:30
Sonia Singh MD: So in late March we're recording this in April, so just a couple weeks ago, a jury agreed with her she settled with TikTok and snap out of court before the trial had happened, but Meta and YouTube were both ordered to pay her$6 million in both compensatory and punitive damages.
3:45
Sonia Singh MD: And this was known as a bellwether case, which means it's the first of many and sets a precedent for other cases like this.
3:51
Sonia Singh MD: So I think we're gonna see more and more of this in the news, and there's a lot of talk about whether this is social media's big tobacco moment, like when we're finally having this reckoning about the harms that social media is doing to us.
4:03
Sonia Singh MD: Of course the platforms and the people who represent them totally disagree that's the case.
4:08
Sonia Singh MD: They argue that you can't have a physical addiction to social media the way you can have to tobacco or drugs.
4:13
Sonia Singh MD: That it's a completely different entity, and that any technology can be used positively or negatively, and those features are there to improve the user experience.
4:20
Sonia Singh MD: And it's really just about how people use or misuse it which is apparently not their responsibility.
4:25
Rebecca Berens MD: Yeah, of
4:26
Sonia Singh MD: course.
4:26
Sonia Singh MD: So that's the inspiration for this episode.
4:31
Sonia Singh MD: I'm curious if you heard about that trial or what you've heard about social media and addiction in the news lately?
4:36
Rebecca Berens MD: Yeah.
4:37
Rebecca Berens MD: So I've heard about this trial.
4:38
Rebecca Berens MD: I didn't know about the verdict, so I'm actually fascinated that's how it ended up.
4:44
Rebecca Berens MD: Because I was not expecting that at all.
4:45
Rebecca Berens MD: Yeah.
4:46
Sonia Singh MD: I think a lot of people weren't.
4:47
Rebecca Berens MD: And yeah, I think it's gonna be.
4:50
Rebecca Berens MD: Really interesting to see the impact of that on the behaviors of these platforms.
4:55
Rebecca Berens MD: Obviously I think we've all seen, the documentaries of whistleblowers from these companies who have shared these concerns many times.
5:02
Sonia Singh MD: Yeah.
5:03
Rebecca Berens MD: And bringing it into trial and getting that kind of a verdict, I think is definitely gonna have an impact in how this ends up.
5:09
Rebecca Berens MD: So
5:10
Sonia Singh MD: one thing that was super interesting is when I was just trying to read about the trial I found it hard to find certain bits of information where I was is this information being suppressed by these algorithms?
5:21
Sonia Singh MD: Because I knew from some stuff that I read that there were internal documents that showed certain discussions happening within Meta about some of these things.
5:31
Sonia Singh MD: So for instance, like an email had gone back and forth where somebody was saying something along the lines of, oh my gosh, we're creating addicts we're basically like drug pushers, and there was another thing about how.
5:40
Sonia Singh MD: They had done internal research on their parental controls and how effective they were and had basically found that the parental controls were not effective in really changing behavior in any way.
5:49
Sonia Singh MD: So they knew that the parental controls were useless and just, performative.
5:53
Rebecca Berens MD: Yeah.
5:53
Sonia Singh MD: And that details on that stuff I found very difficult to find.
5:58
Sonia Singh MD: So anyway.
5:58
Rebecca Berens MD: Interesting.
5:59
Rebecca Berens MD: I'm gonna have to do my own deep dive.
6:00
Rebecca Berens MD: I guess we'll get into a lot of it today, but it
6:02
Sonia Singh MD: warrant some deep dive.
6:03
Rebecca Berens MD: I'm gonna be searching.
6:04
Rebecca Berens MD: Where this was filed and then I'm sure there's some public record documents somewhere that we can dig into if we wanna be real sleuths.
6:10
Sonia Singh MD: Yeah, I didn't go too far into that specific case'cause I had a lot of other ground to cover for this.
6:15
Sonia Singh MD: Of course for this episode.
6:16
Sonia Singh MD: But it may be worth, some digging.
6:18
Sonia Singh MD: So to summarize the claim around this that we're gonna cover, I guess this is a little different than some of our previous episodes.
6:24
Sonia Singh MD: But the claim is just that it's possible to be addicted to social media the way you have addiction to other, you may have addiction to other substances.
6:33
Sonia Singh MD: Inherent in that claim is also that social media is designed to be addictive and that social media can cause significant personal harm.
6:41
Sonia Singh MD: Like when we talk about addiction, it's typically to a substance that people continue using despite harm.
6:47
Sonia Singh MD: And I think, one of the claims that they make in the case is just that children and adolescents are uniquely vulnerable to these potential harms.
6:55
Sonia Singh MD: Of note, we did do a previous episode on social media.
6:58
Sonia Singh MD: The very first full episode we recorded was, is social media Making us unwell?
7:02
Sonia Singh MD: And that episode was really focused on health information on social media rather than just.
7:08
Sonia Singh MD: The algorithms and the platforms generally.
7:11
Sonia Singh MD: And that's an important distinction because that's where this case is really different from a lot of the previous complaints around social media.
7:18
Sonia Singh MD: There's always been complaints that the content is harmful.
7:21
Sonia Singh MD: But there's some legal protections against people of platforms being sued for the content that other users are posting.
7:28
Sonia Singh MD: So they were, essentially immune to a lot of this litigation for a long time.
7:33
Sonia Singh MD: But now this particular case is really pointing to the algorithm itself and the design features of the platform being harmful, which is interesting.
7:42
Sonia Singh MD: And so that's what this episode is gonna focus on.
7:47
Sonia Singh MD: Before I launch into my theories about why now is the time or why this is becoming more viral at this moment, I'm curious what your thoughts are.
7:55
Rebecca Berens MD: I think this is come up a lot, but I think COVID was an inflection point for a lot of people, I think.
8:01
Rebecca Berens MD: When everyone was home around each other more and especially younger people, their only connection to the outside world was often through social media platforms.
8:10
Rebecca Berens MD: I think it gave a lot of parents a window into what was happening in a way that maybe they didn't have before.
8:16
Rebecca Berens MD: Yeah, and I think also, the Gen Z generation that's grown up with social media is older now and speaking out about the effect that it had on them and in a way that they, if they were as teenagers or children, it was maybe not taken as seriously, but now that they're adults, I've heard a lot of like vocal discussion from people in that generation of how it's impacted them.
8:38
Rebecca Berens MD: And so I think, when you're hearing it directly from the person who's been affected, it's it's very compelling.
8:44
Rebecca Berens MD: So I think those are two theories that I have.
8:46
Rebecca Berens MD: And then also I think just the time it takes for litigation to go through, It's not as if this just happened.
8:51
Rebecca Berens MD: This has been building in the background for a while, but like the legal process is slow.
8:55
Rebecca Berens MD: Yeah.
8:55
Rebecca Berens MD: And so now that some of these cases are actually making it to trial and to getting public recognition and media recognition, we're actually hearing about it in a way that we maybe weren't before.
9:07
Sonia Singh MD: I totally agree with everything you just said.
9:08
Sonia Singh MD: And one of the points on my list was that.
9:11
Sonia Singh MD: I think Gen Z reaching kind of full-fledged adulthood, like that generation right now, as of this recording in 2026 is age 14 to 29.
9:20
Sonia Singh MD: So they're coming of age, they're entering the workplace.
9:24
Sonia Singh MD: And that's the first generation to have really been born into social media from the time they were pre-adolescent.
9:29
Sonia Singh MD: And so I think, there's been a lot of talk, not just from Gen Z, but about them Yeah.
9:33
Sonia Singh MD: From
9:34
Rebecca Berens MD: other generations.
9:34
Rebecca Berens MD: Yeah.
9:35
Sonia Singh MD: There's these two book big books over the last few years, the Anxious Generation by Jonathan Het and Dopamine Nation by Anna Lemke.
9:40
Sonia Singh MD: Both really interesting books, but it's funny, when I heard.
9:43
Sonia Singh MD: About the book Anxious Generation.
9:45
Sonia Singh MD: I was like, I don't need to read that.
9:46
Sonia Singh MD: I'm living it.
9:47
Sonia Singh MD: And then I realized that they were talking about Gen Z and I was like, oh, okay.
9:50
Sonia Singh MD: I can read that without being too triggered.
9:52
Rebecca Berens MD: I was pretty triggered.
9:53
Rebecca Berens MD: I dunno.
9:54
Rebecca Berens MD: For me, I was like, oh my gosh, my children, what's going to happen?
9:57
Rebecca Berens MD: But
9:57
Sonia Singh MD: yes.
9:57
Sonia Singh MD: And, but I guess also kind of me,'cause I mean they're talking about them as having that exposure during adolescence, but I see a lot of those same things happening in me, even though I didn't have the exposure until
10:07
Rebecca Berens MD: Yeah.
10:07
Sonia Singh MD: 10 years later.
10:07
Rebecca Berens MD: I feel like it was, we were the unique generation in that we remembered a time before
10:11
Sonia Singh MD: when there wasn't.
10:12
Sonia Singh MD: Yeah.
10:12
Rebecca Berens MD: And so it's maybe more jarring for us.
10:14
Rebecca Berens MD: Yeah.
10:14
Rebecca Berens MD: But also the development effects on us were different that it was for them.
10:18
Sonia Singh MD: Yeah.
10:19
Rebecca Berens MD: Having it at such a younger age.
10:20
Sonia Singh MD: Yeah.
10:21
Sonia Singh MD: Do you, I remember a time, so I think I was in medical school when I got Instagram and I remember a time when.
10:26
Sonia Singh MD: Your Instagram feed would end.
10:27
Sonia Singh MD: Yes.
10:28
Sonia Singh MD: It would be like, that's it.
10:29
Rebecca Berens MD: Like you
10:30
Sonia Singh MD: get, you would get to the bottom of it and you were like, they were like, Nope, no more for you
10:33
Rebecca Berens MD: to put it away.
10:34
Sonia Singh MD: You put it away, you put it down.
10:35
Sonia Singh MD: It's crazy that doesn't happen anymore.
10:37
Sonia Singh MD: Anyway, so a couple other theories that I came up with.
10:39
Sonia Singh MD: I think one is just that social media use is so pervasive.
10:42
Sonia Singh MD: We are all having the experience we're all feeling this or seeing this in some way.
10:46
Sonia Singh MD: So even if you are not somebody who is actively using a social media platform, you are probably observing or around somebody who is, like my dad who's 78 years old, is not on any social media platforms, but he sees my mom, he is sitting next to my mom scrolling Facebook on a regular basis.
11:01
Sonia Singh MD: So he is seeing the effects of it even though he's not on it.
11:04
Sonia Singh MD: There's a study that found that 71% of Americans are using Facebook.
11:07
Sonia Singh MD: I think for teens, the number is 80 something percent.
11:11
Sonia Singh MD: So I think one is just like we're all seeing and feeling the effects.
11:14
Sonia Singh MD: Another thing is that the platforms have gotten progressively more effective.
11:18
Sonia Singh MD: We were just talking about how the feed used to end and now it's infinite scroll.
11:21
Sonia Singh MD: You can go on and on forever.
11:22
Sonia Singh MD: It's getting really good at figuring out what content you wanna see and what you might like, and there's more and more content.
11:27
Sonia Singh MD: So whatever bizarre niche you like are interested in, there's gonna be content around it.
11:32
Sonia Singh MD: And so I think they've just gotten very good at keeping our attention.
11:36
Sonia Singh MD: And then the other thing is just that we've been here before, we've been here before with tobacco and there was a time when doctors were smoking and, it was perfectly acceptable.
11:46
Sonia Singh MD: It was
11:47
Rebecca Berens MD: like an ashtray on
11:48
Sonia Singh MD: LD.
11:51
Sonia Singh MD: I think we just now, and maybe the last five to 10 years have started to have some of that reckoning with alcohol where, we're realizing that the amounts of alcohol consumption that was maybe socially sanctioned or considered moderate use and okay.
12:03
Sonia Singh MD: And healthy is perhaps not as healthy as we thought it was.
12:07
Sonia Singh MD: And so I think, we're following a similar pathway with some of this social media stuff.
12:12
Sonia Singh MD: And, I think this could potentially be an inflection point where we really start examining this more critically and saying okay, is this actually causing harm?
12:22
Sonia Singh MD: And I think it's also evidenced by the rise of technologies to help us stop using these technologies.
12:28
Sonia Singh MD: Sometimes I wonder is it normal?
12:30
Sonia Singh MD: How hard it is for me to not use these things?
12:32
Sonia Singh MD: But then when I see the proliferation of app limits and all these apps to help you stop using the apps and the brick and all these other things that people are, all these strategies people are employing to not use it.
12:42
Sonia Singh MD: I'm like, okay, clearly there's other people in this boat and this is a common problem.
12:46
Rebecca Berens MD: Yeah.
12:46
Rebecca Berens MD: Yeah.
12:46
Rebecca Berens MD: I've talked about my use of brick before on this podcast and it, yeah, I mean I had been targeted at me on social media actually multiple times and it was like a, how do you know to target me?
12:58
Rebecca Berens MD: Am I clearly exhibiting this addictive behavior probably.
13:02
Rebecca Berens MD: And yeah it's really interesting how we've had to develop these ways around it because it is not something that you can just stop.
13:10
Sonia Singh MD: Yeah.
13:10
Rebecca Berens MD: No matter how hard you might try.
13:12
Rebecca Berens MD: And I'm sure we'll get into all of this, but I think that is further evidence of maybe some, more serious neurobiology behind this than just it's fun.
13:21
Rebecca Berens MD: Yes.
13:21
Rebecca Berens MD: Actually, I just
13:22
Sonia Singh MD: had a friend of mine post a story, a picture of him unboxing his brick and he was like, I've never been so excited to get a piece of technology to help me not use other pieces of technology in my life.
13:32
Sonia Singh MD: And I just thought it was so funny and ironic that he was posting a story about getting his brick, so anyway, so let's get into some of the facts and put some context and some nuance to them.
13:43
Sonia Singh MD: So first of all, let's just talk about what defines addiction, because I think one of the big criticisms of people saying social media addiction is a thing, is just people will say, addiction is a really strong word.
13:54
Sonia Singh MD: It means a specific thing.
13:56
Sonia Singh MD: We shouldn't throw the word around willy-nilly.
13:58
Sonia Singh MD: And that should really be reserved for a very particular pathology.
14:01
Sonia Singh MD: And this is not that.
14:03
Sonia Singh MD: So let's just talk about what addiction is.
14:05
Sonia Singh MD: So the American Society of Addiction Medicine defines addiction as a treatable chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences where people use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
14:24
Sonia Singh MD: So that is a more fleshed out, formal definition of addiction.
14:28
Sonia Singh MD: However, the medical community is moving away from the term addiction and moving towards a more general neutral term, which is substance use disorder.
14:36
Sonia Singh MD: And so that's more of a spectrum on which people with severe substance use disorder would be categorized as what we think of as addiction.
14:44
Sonia Singh MD: But, the other end of that spectrum could just be like.
14:47
Sonia Singh MD: Compulsive use or problematic use or substance abuse.
14:50
Sonia Singh MD: So as with any diagnosis in medicine, there's very specific diagnostic criteria for something to be considered a substance use disorder.
14:57
Sonia Singh MD: So you need to have two or three of the following criteria over the past 12 months to qualify as having a substance use disorder.
15:05
Sonia Singh MD: And the categories for this are impaired control, social impairment, risky use, and pharmacologic criteria.
15:12
Sonia Singh MD: So I'm just gonna quickly run through them and I want you in your mind to think about if you can apply this to your social media use.
15:19
Sonia Singh MD: Okay.
15:20
Sonia Singh MD: Taking the substance in larger amounts or longer than intended, persistent desire or unsuccessful efforts to cut down or control, use, great deal of time spent obtaining, using, or recovering from the substance, craving, or strong desire or urge to use the substance.
15:33
Sonia Singh MD: Failure to fulfill major role obligations at work, school, or home.
15:37
Sonia Singh MD: Continued use despite persistent social or interpersonal problems, important activities given up or reduced because of substance use.
15:44
Sonia Singh MD: Sleep, I think is like popping up in my mind.
15:46
Rebecca Berens MD: Yeah.
15:46
Sonia Singh MD: Recurrent use in physically hazardous situations, checking your feed while driving, continue use despite knowledge of persistent physical or psychological problems caused by or exacerbated by the substance tolerance need for increasing amounts or diminished effect from the same amount withdrawal symptoms or having to use to relieve or avoid withdrawal.
16:07
Sonia Singh MD: So tell me how you feel when you hear that list.
16:09
Rebecca Berens MD: Yeah I think we have all experienced and observed this, these exact symptoms in either ourselves or people we know when it comes to social media use.
16:20
Rebecca Berens MD: We just talked about persistent desire, unsuccessful efforts to cut down or control, use.
16:24
Rebecca Berens MD: Yes.
16:24
Rebecca Berens MD: Literally purchasing devices to help us, to help
16:26
Sonia Singh MD: you not use
16:27
Rebecca Berens MD: your
16:27
Sonia Singh MD: devices.
16:28
Sonia Singh MD: Yes.
16:28
Rebecca Berens MD: I think this is definitely very applicable.
16:31
Rebecca Berens MD: Yeah.
16:31
Rebecca Berens MD: And yeah, it's, it is actually, these are all things I inherently knew, but I've never seen the list written out like this and read it all at once.
16:39
Rebecca Berens MD: And I'm like,
16:39
Sonia Singh MD: okay.
16:39
Sonia Singh MD: Rebecca, let's take a step further and together we're going to do a shorter version of a questionnaire that's a validated questionnaire for social media addiction, which note, is not actually a diagnosis.
16:52
Sonia Singh MD: So this is not diagnosing anything, but it is a validated questionnaire in that results are very consistent across administrations of this test.
16:59
Sonia Singh MD: And it seems to be measuring something, we'll call it problematic social media use.
17:05
Sonia Singh MD: Okay, so I'm gonna ask you the questions right now here live and you're gonna answer them.
17:08
Sonia Singh MD: Oh
17:08
Rebecca Berens MD: man, this is gonna be embarrassing.
17:09
Sonia Singh MD: Okay.
17:10
Sonia Singh MD: Okay.
17:10
Sonia Singh MD: So the choices are very rarely, sometimes, often.
17:13
Sonia Singh MD: Very often you spend a lot of time thinking about social media or planning how to use it.
17:18
Sonia Singh MD: So very rarely, sometimes, often, or very.
17:23
Sonia Singh MD: I'm gonna say sometimes.
17:25
Sonia Singh MD: Okay.
17:26
Sonia Singh MD: Next is you feel an urge to use social media more and more?
17:31
Sonia Singh MD: Very rarely, sometimes, often, or very often.
17:34
Rebecca Berens MD: I'm gonna say often.
17:35
Sonia Singh MD: Okay.
17:37
Sonia Singh MD: You use social media in order to forget about personal problems, don't we all?
17:42
Rebecca Berens MD: Yeah.
17:42
Rebecca Berens MD: I'm gonna say often.
17:43
Sonia Singh MD: Okay.
17:44
Sonia Singh MD: You have tried to cut down on the use of social media without success?
17:48
Sonia Singh MD: Very often.
17:49
Sonia Singh MD: Very often.
17:49
Sonia Singh MD: Okay.
17:49
Sonia Singh MD: I can answer that one for you.
17:51
Sonia Singh MD: You become restless or troubled if you are prohibited from using social media.
17:56
Rebecca Berens MD: Okay.
17:56
Rebecca Berens MD: What was the, what were the lower categories?
17:58
Sonia Singh MD: Very rarely, sometimes.
18:00
Rebecca Berens MD: Okay.
18:00
Rebecca Berens MD: I'm gonna say
18:06
Sonia Singh MD: this is getting at withdrawal, right?
18:08
Rebecca Berens MD: Yeah.
18:08
Rebecca Berens MD: Yeah.
18:08
Rebecca Berens MD: And I, it's interesting'cause like I was worried about that when I got the brick.
18:11
Rebecca Berens MD: Yes.
18:12
Rebecca Berens MD: But it was not as bad as I expected.
18:14
Rebecca Berens MD: Okay.
18:14
Rebecca Berens MD: I was pleasantly surprised.
18:16
Rebecca Berens MD: I'm gonna say rarely,
18:18
Sonia Singh MD: maybe.
18:19
Sonia Singh MD: Okay.
18:19
Sonia Singh MD: Okay.
18:19
Sonia Singh MD: Okay, last question.
18:21
Sonia Singh MD: You use social media so much that it has had a negative impact on your job or studies?
18:30
Rebecca Berens MD: I'm gonna say sometimes.
18:31
Sonia Singh MD: Okay.
18:33
Sonia Singh MD: Let's see what you got.
18:34
Sonia Singh MD: High addiction.
18:35
Sonia Singh MD: Yeah, high level of addiction.
18:37
Rebecca Berens MD: Okay.
18:37
Rebecca Berens MD: This is not surprising to me in the least.
18:38
Rebecca Berens MD: So
18:39
Sonia Singh MD: I thought before I did any of this, that I feel like I'm on the spectrum of social media usage.
18:44
Sonia Singh MD: I feel like I'm in a less than average category.
18:47
Sonia Singh MD: I think I'm actually below average probably in my overall social media usage and impairment from my social media and desire to use social media.
18:55
Sonia Singh MD: But I answered yes to a lot of the, I've tried to cut down'cause I feel like maybe I'm just like more aggressively trying to not use it than maybe some other people.
19:03
Sonia Singh MD: But even I had moderate addiction, so I was like, are we all addicted
19:07
Rebecca Berens MD: to you?
19:07
Rebecca Berens MD: I probably,
19:09
Sonia Singh MD: Anyway, one of the big okay.
19:11
Sonia Singh MD: So anyway, we're both addicts.
19:12
Sonia Singh MD: Yeah.
19:12
Sonia Singh MD: We've accepted it.
19:14
Sonia Singh MD: Okay.
19:14
Rebecca Berens MD: Which I think we should talk about that term also, but we can get to that.
19:17
Sonia Singh MD: Okay.
19:18
Sonia Singh MD: Fair.
19:18
Sonia Singh MD: I wanna hear that criticism down the road.
19:20
Sonia Singh MD: Yeah.
19:20
Sonia Singh MD: Okay.
19:20
Sonia Singh MD: So a big criticism of this whole idea is that, drugs are a thing that goes in your body and does this physiologic stuff to you and, alters your brain and your cells.
19:32
Sonia Singh MD: And then you have this physical withdrawal syndrome and you have this physical tolerance.
19:37
Sonia Singh MD: And so I think a lot of times when people are reluctant to put this labeling on social media, it's because it's a behavior and it seems very different than taking heroin or meth, a drug, right?
19:49
Sonia Singh MD: But I think there's a couple of counter arguments to that.
19:52
Sonia Singh MD: So one is there's already precedent for the this, which is gambling.
19:55
Sonia Singh MD: Okay.
19:55
Sonia Singh MD: So gambling is a behavior, it's not a substance.
19:59
Sonia Singh MD: And it's a behavioral addiction.
20:00
Sonia Singh MD: So actually in DSM four, which was the previous version of the diagnostic manual that we use in psychiatric medicine, gambling was labeled as pathologic gambling.
20:10
Sonia Singh MD: Rather than gambling addiction.
20:12
Sonia Singh MD: But they found that the research had evolved on this.
20:14
Sonia Singh MD: And basically, even though it is a behavior, the clinical expression, brain origins, comorbidities, physiology, and treatment are all basically the same as substance use disorders.
20:25
Sonia Singh MD: And so in the DSM five, they renamed it as gambling disorder and categorized it as an addictive disorder.
20:32
Sonia Singh MD: Of note, there is also something called internet gaming disorder, but that is currently listed in section three of the DSM five, which is where they list things that are not yet considered formal disorders but are kind of contenders because there seems to be enough research that something is there, but at this point it has not proven that there is significant impairment or distress, and so it's not officially a diagnosis yet.
20:55
Sonia Singh MD: So I guess the bottom line that I take from a lot of this discussion of criteria and naming is just that.
21:01
Sonia Singh MD: The medical community is not taking these terms lightly.
21:03
Sonia Singh MD: We're not just throwing around these words or labeling people without a lot of researcher and evidence to support that is a distinct pathology that is worth naming.
21:13
Sonia Singh MD: This is just happening for gambling and gaming, which have been around for a really long time.
21:18
Sonia Singh MD: As you said, these things move really slowly and this is a relatively new technology.
21:22
Sonia Singh MD: So I would not be surprised if at some point, the research on this topic evolves to the point mark my words, at some point there is going to be like a problematic social media use.
21:33
Rebecca Berens MD: Yeah.
21:33
Sonia Singh MD: And then eventually, I bet you that we'll get elevated to the level of social media use disorder.
21:39
Rebecca Berens MD: Yeah.
21:39
Sonia Singh MD: So that's my prediction.
21:41
Sonia Singh MD: And it's gonna be immortalized in this podcast.
21:43
Sonia Singh MD: So someday I'll come back and say, I told
21:45
Rebecca Berens MD: you we'll cite.
21:45
Sonia Singh MD: Okay, so that's point number.
21:47
Sonia Singh MD: Do you have any thoughts on that before I move
21:48
Rebecca Berens MD: on?
21:48
Rebecca Berens MD: Yeah, I totally agree and a lot of what comes up for me is like the controversy around the concept of food addiction.
21:54
Rebecca Berens MD: Which I think has a lot of similar concerns around it and using that term especially.
22:01
Rebecca Berens MD: 'cause food is not something you can abstain from.
22:03
Sonia Singh MD: Right.
22:03
Rebecca Berens MD: You can abstain from gambling, you can abstain from social media playing video games.
22:07
Rebecca Berens MD: You can abstain from social media, you cannot abstain from food.
22:10
Sonia Singh MD: Yeah.
22:10
Rebecca Berens MD: But I think there's, there are some behavioral things around food that sometimes can approach addiction like behaviors.
22:18
Rebecca Berens MD: And so there's a lot of controversy on that topic also.
22:20
Rebecca Berens MD: So I'm seeing a lot of mirroring there and like we've talked about in previous podcasts, it's very difficult to avoid social media use now, you could technically abstain from it.
22:28
Sonia Singh MD: Yeah.
22:29
Rebecca Berens MD: But it would actually really limit your.
22:32
Rebecca Berens MD: Social interaction.
22:34
Sonia Singh MD: Yeah.
22:34
Rebecca Berens MD: Nowadays.
22:34
Sonia Singh MD: Yeah.
22:35
Rebecca Berens MD: So I think it's, it just brings up a lot of similarities for me of that conversation.
22:39
Rebecca Berens MD: And maybe we should do a whole other episode about the concept of food addiction.
22:42
Sonia Singh MD: Yeah.
22:42
Rebecca Berens MD: Because I'm seeing a lot of overlap there.
22:45
Sonia Singh MD: Yeah.
22:45
Sonia Singh MD: I think that would be, is that what your thoughts were around the word addiction
22:48
Rebecca Berens MD: thought?
22:48
Rebecca Berens MD: I think so.
22:49
Rebecca Berens MD: I think for me the term addict is, there are some people who use that term to describe themselves and find it useful.
22:57
Rebecca Berens MD: And then I think it also becomes an identity that Can be potentially harmful in someone's recovery.
23:03
Rebecca Berens MD: And so I think we just have to be very careful about using that term.
23:05
Rebecca Berens MD: And for me, I think if the person finds it useful to understand that I'm a person who has this predisposition and I know that when I'm exposed to substances or behaviors or whatever it is that I start reacting to in this way, I know it's becoming problematic.
23:21
Rebecca Berens MD: And that ident identity to me is helpful.
23:23
Sonia Singh MD: Yeah.
23:24
Rebecca Berens MD: But I think it also is a term that is weaponized societally is you're just like that.
23:29
Rebecca Berens MD: You're never gonna change.
23:31
Rebecca Berens MD: You're just a bad person.
23:32
Rebecca Berens MD: It has a lot of negative connotations to it, so I'm just very careful with that term.
23:35
Rebecca Berens MD: Again, like if a person finds it helpful for themselves.
23:38
Sonia Singh MD: Yeah.
23:39
Rebecca Berens MD: I think that's one thing, but I, it's not a term that I would ever use to describe someone of my own volition without hearing it from them.
23:46
Rebecca Berens MD: And then even if they are saying about themselves what does that mean that you believe about yourself?
23:49
Rebecca Berens MD: 'Cause it's, it, I think it can become an identity that's really hard to shake.
23:54
Rebecca Berens MD: And I see this a lot.
23:55
Rebecca Berens MD: There's so much overlap with eating disorders and substance use disorder, neurobiologically.
23:59
Rebecca Berens MD: Yeah.
23:59
Rebecca Berens MD: And I see this a lot with patients and I think this happens with the eating disorder identity.
24:02
Rebecca Berens MD: Like I have an eating disorder, so like this is how I am.
24:05
Rebecca Berens MD: And I can never change, and I can never recover.
24:08
Rebecca Berens MD: And
24:08
Sonia Singh MD: yeah.
24:08
Rebecca Berens MD: And I just don't believe that to be true.
24:10
Rebecca Berens MD: It's difficult, but it's possible.
24:12
Rebecca Berens MD: And I think if we use that term as an identity, we can really limit some people from being able to reach recovery.
24:19
Rebecca Berens MD: So I just don't like using the term myself for other people.
24:24
Rebecca Berens MD: And again if some, there's someone listening to this podcast who describes themselves that way and finds it helpful.
24:29
Rebecca Berens MD: Yeah.
24:29
Rebecca Berens MD: I think that's totally up to you.
24:31
Rebecca Berens MD: But I think it's important for us as clinicians and professionals to not be using that term in a way that might be unhelpful to our patients.
24:39
Sonia Singh MD: Totally hear you.
24:40
Sonia Singh MD: So I'm gonna say we are suffering from social media addictions.
24:44
Rebecca Berens MD: Yes.
24:44
Sonia Singh MD: Okay.
24:45
Rebecca Berens MD: I, and I would say I am someone who I know has a, has the neurobiology.
24:52
Rebecca Berens MD: To.
24:53
Rebecca Berens MD: Have addictions.
24:54
Rebecca Berens MD: I know that about myself.
24:56
Sonia Singh MD: Yeah.
24:56
Rebecca Berens MD: I, it's, it is run strongly in my family.
24:58
Rebecca Berens MD: It is like the experience of having an eating disorder.
25:03
Rebecca Berens MD: I understand what addiction feels like.
25:05
Sonia Singh MD: Yeah.
25:05
Rebecca Berens MD: It's, and so I think that I think, for me, I actually don't mind it if someone uses that term about me.
25:12
Rebecca Berens MD: But I just think that it's important for like identity purposes to not differentiate from your identity, not give someone that identity that they don't deserve.
25:21
Sonia Singh MD: Got it.
25:22
Sonia Singh MD: Yeah.
25:22
Sonia Singh MD: Okay.
25:22
Sonia Singh MD: So let's go through now.
25:24
Sonia Singh MD: Okay.
25:24
Sonia Singh MD: So first we talked about the fact that yes, behavioral addiction is a thing that seems to exist already.
25:30
Sonia Singh MD: Exists with gambling.
25:32
Sonia Singh MD: So another argument against the idea that, you cannot have a addiction to something like social media is the physiologic effects that it has on the brain.
25:40
Sonia Singh MD: So I'm gonna go through a few studies that have examined this and, I think we all know that there's a, there's this link with social media and likes and notifications in dopamine, but, you rarely measure dopamine in a study because dopamine is a neurotransmitter that's in these very protected brain spaces.
25:57
Sonia Singh MD: So most of these studies are gonna be looking at changes in structural parts of, structural changes in the brain and also, changes in function that are happening when people are using social media.
26:07
Sonia Singh MD: So the first study was called social media use and Early adolescent brain Structure, the A, B, CD study.
26:13
Sonia Singh MD: So they looked at over 7,000 participants, ages 10 to 13, and had them.
26:18
Sonia Singh MD: Self-report, their social media use.
26:20
Sonia Singh MD: And then they also had them do a social media addiction questionnaire.
26:23
Sonia Singh MD: Actually, I think it was the same, the Bergen questionnaire, the same one you just did.
26:26
Sonia Singh MD: So after adjusting for demographic socioeconomic factors, genetic ancestry, non-social media, screen time and other features, they found that there was a significant association with higher average daily social media use and lower total cortical thickness and volume of their brains.
26:44
Sonia Singh MD: And the brain regions that had the most differences were the prefrontal cortex, the temporal lobe, the occipital lobe, the and the parietal lobe.
26:51
Sonia Singh MD: And so these are basically all areas that correspond with not only our reward system, but executive functioning, visual processing, and attention networks.
27:00
Sonia Singh MD: So that's interesting.
27:03
Sonia Singh MD: Yeah.
27:03
Sonia Singh MD: It seems that in these kids, now the question of course is Is this correlation or causation?
27:09
Sonia Singh MD: Yeah.
27:09
Sonia Singh MD: Are these kids who have brains that already look like this, just using the social media more because of those underlying differences?
27:16
Sonia Singh MD: Or is it the social media that's driving that?
27:19
Sonia Singh MD: So this next study tries to answer that question'cause it's more longitudinal.
27:23
Sonia Singh MD: So this one is called association of Habitual Checking Behaviors on Social Media with Longitudinal Functional Brain Development.
27:30
Sonia Singh MD: And this was in JAMA Pediatrics.
27:31
Sonia Singh MD: This was actually over and over in a lot of articles and studies that talked about this topic.
27:36
Sonia Singh MD: So they took a cohort of 169, sixth and seventh graders from three different public schools in nor rural North Carolina.
27:43
Sonia Singh MD: So these are American kids, followed them for three years and did functional MRIs on them every single year.
27:49
Sonia Singh MD: And ask them to do a social incentive delay task in which they were given some social feedback and then asked to push some buttons.
27:57
Sonia Singh MD: And then And along with that, they were also self-reporting how often they were checking social media.
28:03
Sonia Singh MD: So note, all of this is self-report too, which like, I think there's also data to show that we typically, we have a time distortion that happens with social media.
28:10
Sonia Singh MD: So it's hard to actually accurately gauge how much time you're using it.
28:14
Sonia Singh MD: But in that study, a higher frequency of social media checking was associated with altered development over time of key brain regions, including the ventral striatum, which is the reward center, the amygdala, which is involved in emotional processing and fear, and the prefrontal cortex, which is part of your executive function in inhibitory control.
28:33
Sonia Singh MD: So adolescents who checked.
28:36
Sonia Singh MD: Social media more habitually also showed initial hypo activation in some of those areas.
28:42
Sonia Singh MD: So like on the baseline study, they, those areas were maybe less active, but.
28:46
Sonia Singh MD: They had over time increasing sensitivity in those reward related regions, suggesting that the brain becomes tuned to anticipate social feedback.
28:55
Sonia Singh MD: And so this is the same pattern that's observed with a lot of different addictions to other substances.
29:02
Sonia Singh MD: So it seems like there's this interplay going on where it's like some kids have this baseline reward system that's a little bit hypo activated.
29:09
Sonia Singh MD: And so maybe those kids are seeking more of that dopamine hit from checking the social media frequently.
29:17
Sonia Singh MD: And one of the design features about social media that makes it such a dopamine hit is the unpredictability of it.
29:23
Sonia Singh MD: Yes.
29:23
Sonia Singh MD: You post something and you don't know if anyone's gonna like it or how many people are gonna like it.
29:26
Sonia Singh MD: You don't know when you're gonna get a notification.
29:28
Sonia Singh MD: You don't know when you're gonna get a DM from somebody.
29:30
Sonia Singh MD: And so it's that unpredictability.
29:33
Sonia Singh MD: The same with gambling that makes it, yeah.
29:36
Sonia Singh MD: Dopaminergic basically,
29:37
Rebecca Berens MD: what is that psychological service like variable response or something like that for Yeah.
29:41
Rebecca Berens MD: Yeah, and it's, this sort of supports what we're saying, there's initial predisposition, right?
29:44
Rebecca Berens MD: Maybe there's something about the brain that is different at baseline.
29:47
Rebecca Berens MD: But then it changes in response to the input habitual
29:52
Sonia Singh MD: checking.
29:52
Rebecca Berens MD: The habitual checking.
29:53
Sonia Singh MD: Right.
29:54
Rebecca Berens MD: And yeah, so it's it's not just that using social media causes this to happen to you.
29:59
Rebecca Berens MD: Maybe you have a predisposition for it and you're more susceptible.
30:03
Sonia Singh MD: Right.
30:03
Rebecca Berens MD: And then you are someone who becomes.
30:06
Rebecca Berens MD: More attuned and then Yeah.
30:07
Rebecca Berens MD: Worsens over time
30:08
Sonia Singh MD: right,
30:08
Rebecca Berens MD: yeah.
30:09
Sonia Singh MD: Yeah.
30:09
Sonia Singh MD: And one of the things I was listening to about this, they kept drawing these analogies to gambling.
30:13
Sonia Singh MD: And then, they mentioned how even just the mechanism of pull down to refresh something is exactly a slot machine.
30:21
Sonia Singh MD: What I thought about that, I was like, oh my God.
30:24
Sonia Singh MD: It's like a, every time you refresh your inbox, it's like pulling this lot and being like, am I gonna get a fun email?
30:29
Sonia Singh MD: Some good news gonna come to my inbox.
30:32
Sonia Singh MD: Okay, so moving on to the next study, which I thought was one of the most interesting.
30:36
Sonia Singh MD: So this one.
30:38
Sonia Singh MD: Was very small.
30:39
Sonia Singh MD: So I will admit this is a very small study.
30:41
Sonia Singh MD: So this was 20 college students that were recruited and then randomly assigned to either a control group or a social media group.
30:48
Sonia Singh MD: So there was 10 in each group, and they used a technology called Functional near Infrared SPECT spectroscopy, which I had actually never heard of.
30:56
Sonia Singh MD: Yeah, I've
30:56
Rebecca Berens MD: never heard of that.
30:57
Sonia Singh MD: It's basically a little scalp cap with a bunch of sensors and it's measuring blood flow in the more superficial aspects of the brain.
31:04
Sonia Singh MD: So it's like a very liked version of FMRI, but it's not giving you nearly the structural information or the detail, it's just giving you like some blood flow information, like superficial aspects of the brain.
31:13
Sonia Singh MD: Including the prefrontal cortex, which is the area that we're interested in for this type of stuff.
31:17
Sonia Singh MD: Basically they had all the participants do wear the cap and do this executive functioning test.
31:23
Sonia Singh MD: So it's a test of working memory and inhibitory control.
31:26
Sonia Singh MD: And then they also had them fill out an emotion questionnaire that was trying to get a sense of their emotional state.
31:32
Sonia Singh MD: Once they had that baseline, they had them deep breathe and relax for a few minutes, and then they did either 15 minutes of scrolling on their own Instagram feed without engaging in anything or scrolling a preloaded Instagram account of neutral black and white photos and videos of nature with neutral captions.
31:48
Sonia Singh MD: So no emotional salience basically.
31:51
Sonia Singh MD: And then they all did the same executive functioning task again, and then also completed the same emotion questionnaire again.
31:57
Sonia Singh MD: Of note, they screened all 20 patients with the social media addiction questionnaire that we did, and 55% qualified as addicted to social media.
32:07
Sonia Singh MD: So we're not alone.
32:08
Sonia Singh MD: 80% of the social media group so th this was a caveat here.
32:12
Sonia Singh MD: Yeah.
32:12
Sonia Singh MD: So there were only 10 people in each group and in the social media group, eight of them qualified as social media addicted and 30% in the control group.
32:19
Sonia Singh MD: So there was a very significant,
32:21
Rebecca Berens MD: why didn't they split
32:22
Sonia Singh MD: them?
32:22
Sonia Singh MD: Did they do this after the fact?
32:24
Sonia Singh MD: I think they just randomized them and then it turned out that one group had too many, so it can't really un randomize someone, unfortunately,
32:30
Rebecca Berens MD: because then that makes this annoying
32:32
Sonia Singh MD: the results.
32:32
Sonia Singh MD: Yeah.
32:33
Sonia Singh MD: Hard to interpret.
32:34
Sonia Singh MD: Yeah.
32:34
Sonia Singh MD: And and when the group is so small, like this can happen,
32:36
Rebecca Berens MD: right?
32:36
Rebecca Berens MD: Yeah.
32:37
Sonia Singh MD: So anyway take all of the results here with a grain of salt.
32:41
Sonia Singh MD: But I guess one thing they would maybe argue is that what they're really measuring in this is what is the change from pre and post the intervention?
32:48
Sonia Singh MD: Okay.
32:48
Sonia Singh MD: The delta.
32:49
Sonia Singh MD: So maybe the other people have baseline features that are different, but one would hope that the delta would still be something worth looking at.
32:57
Sonia Singh MD: But as we learned from the previous study, they have both a different baseline.
33:02
Sonia Singh MD: Yeah.
33:02
Sonia Singh MD: And they have a different delta.
33:04
Rebecca Berens MD: Yeah, that's the thing.
33:05
Rebecca Berens MD: I'm like, if you're baseline more predisposed right.
33:08
Rebecca Berens MD: Then you may have a larger effect size anyway.
33:10
Rebecca Berens MD: Even if, yeah.
33:11
Rebecca Berens MD: So you
33:12
Sonia Singh MD: are correct, but you are correct.
33:13
Sonia Singh MD: Okay.
33:14
Sonia Singh MD: But the social media group had reduced inhibitory control following exposure to social media.
33:19
Sonia Singh MD: And what inhibitory control means is just holding yourself back from doing a thing that you were tempted to do by inertia or craving or whatever.
33:26
Sonia Singh MD: And then The social media group also had lower accuracy on their cognitive task, and they had increased activity in a certain part of the brain that corresponds to increased cognitive effort in that group.
33:37
Sonia Singh MD: So basically they had to expend more effort to do the same executive functioning task following the intervention, which was scrolling the social media.
33:45
Sonia Singh MD: They also had, after the intervention, decreased activity in certain brain areas that suggested diminished capacity to effectively manage working memory and inhibit inappropriate responses.
33:56
Sonia Singh MD: So basically it was harder to do the task.
33:58
Sonia Singh MD: Their working memory was poor and their ability to in inhibit, responses they did not wanna have was also challenge.
34:06
Sonia Singh MD: There was no change in emotional state based on the questionnaires pre or post intervention or between the groups.
34:11
Sonia Singh MD: So the bottom line was that even brief passive social media use, like this was only 15 minutes.
34:17
Sonia Singh MD: And think about how many, on average minutes are being spent per day on these platforms.
34:21
Sonia Singh MD: And it was completely passive.
34:22
Sonia Singh MD: They were not engaging anything may impair cognitive function, including inhibitory control and working memory.
34:28
Sonia Singh MD: And you know what this study made me think.
34:30
Sonia Singh MD: So again, this is not great, it's a small sample size and there are some issues with the the comparisons between the groups.
34:36
Sonia Singh MD: But this just made me think of brain fog.
34:39
Sonia Singh MD: So like brain fog was not a thing that anybody talked about 10 years ago.
34:43
Sonia Singh MD: No one came in and was talking to me about their brain fog until maybe 2018.
34:47
Sonia Singh MD: I started hearing a little stuff about brain fog.
34:48
Sonia Singh MD: But after the pandemic, it's just so much brain fog, right?
34:52
Sonia Singh MD: When people are describing brain fog I think these are some of the things that they're describing.
34:56
Rebecca Berens MD: Yep.
34:57
Sonia Singh MD: And when you're having this huge collective exposure where all of us are like, 80% of us are doing this thing, you gotta think I wonder if that's,
35:05
Rebecca Berens MD: it's certainly not helping, I don't wanna suggest that there's nothing biological else going on, but it's certainly not helping.
35:13
Sonia Singh MD: No I totally there.
35:14
Sonia Singh MD: Brain fog is a non-specific symptoms that it can be caused by a variety of things.
35:18
Sonia Singh MD: I'm not saying it's all from this, but I'm just saying this is not on the top of anyone's list of possibilities.
35:24
Sonia Singh MD: When they come in and they're like, they're usually just what about my thyroid?
35:26
Sonia Singh MD: And what about perimenopause and what about anemia and what about my blood sugar?
35:29
Sonia Singh MD: No one's what about my social media use?
35:32
Sonia Singh MD: Do you think that's a problem?
35:33
Sonia Singh MD: And I think, that we should really be thinking about that.
35:35
Sonia Singh MD: 'cause I, I think there's evidence that certainly for certain people there's probably a pretty significant effect on cognition.
35:42
Rebecca Berens MD: Yeah, absolutely.
35:43
Sonia Singh MD: Okay, so the next, question to ask about whether we can call this an addiction.
35:48
Sonia Singh MD: So we've shown that even though it's not a pill, it's not a substance that you ingest.
35:53
Sonia Singh MD: It is having these very powerful biological and physiological effects.
35:58
Sonia Singh MD: Now the next question is, but is it really causing harm or impairment?
36:02
Sonia Singh MD: And I think that's a hard question to answer.
36:04
Sonia Singh MD: We don't wanna pathologize relatively human behavior that's just happening in response to a new technology.
36:10
Sonia Singh MD: I tried to summarize some of the data on the harms of social media.
36:14
Sonia Singh MD: So obviously there's a lot of studies around mental health, but most of these are showing correlations, not causations.
36:19
Sonia Singh MD: And these associations, even when they exist, are relatively small.
36:24
Sonia Singh MD: But social media use has been associated with various negative outcomes.
36:27
Sonia Singh MD: So the data is strongest for adolescents and young adults and for people who are using heavily, which is defined as greater than three hours per day.
36:34
Sonia Singh MD: There are several meta-analyses that have shown positive associations between problematic use.
36:39
Sonia Singh MD: So that's looking at only people who are using heavily or are scoring high on some of these questionnaires.
36:45
Sonia Singh MD: So that is associated with depression, anxiety, and sleep problems, and just general negative associations with wellbeing.
36:52
Sonia Singh MD: All those meta-analyses note that it appears to be a bi-directional relationship where patients who are already depressed may.
37:00
Sonia Singh MD: Then driven to use their social media more and then that may then worsen their depression.
37:06
Sonia Singh MD: So it's like a chicken or the egg situation where it's hard to know, what was the initial trigger?
37:10
Rebecca Berens MD: Yeah.
37:11
Sonia Singh MD: Potential mechanisms for why they would cause that harm.
37:14
Sonia Singh MD: We talked a little bit about some of the like biochemical brain physiology around it, the pathway there is often is mediated by sleep disruption, so it's displacing sleep or interfering with sleep.
37:23
Sonia Singh MD: And then that is leading to downstream effects on mood and wellbeing.
37:27
Sonia Singh MD: But then the other potential mechanisms of harm are cyber bullying exposure, social comparison poor emotional regulation displacing in-person social interactions.
37:37
Sonia Singh MD: And then as we've talked about on this podcast multiple times, exposure to harmful content that can result in disordered eating, substance use, self-harm.
37:44
Sonia Singh MD: I would add medical misinformation to that.
37:47
Rebecca Berens MD: Yeah, absolutely.
37:47
Sonia Singh MD: So the content itself can also cause you harm.
37:50
Sonia Singh MD: So there was one meta-analysis that found that frequent social media users compared to infrequent social media users between the ages of 10 and 19 also had increased risks of alcohol consumption, tobacco use, drug use, sexually risky behaviors, and gambling.
38:05
Sonia Singh MD: That study I was surprised by some of those findings and to me.
38:10
Sonia Singh MD: That kind of seems like it probably is tracking along with other predispositions, genetic predispositions and also like poverty and neglect and adverse childhood events.
38:20
Rebecca Berens MD: Yeah.
38:20
Sonia Singh MD: The kids that are maybe spending the most amount of time on social media are maybe just being neglected or,
38:26
Rebecca Berens MD: yeah, because I think most parents, even if they aren't aware of all the harms of social media, if you are an engaged parent Yeah.
38:32
Rebecca Berens MD: And you're seeing your kid on social media all time and
38:34
Sonia Singh MD: your child's going to school,
38:35
Rebecca Berens MD: right.
38:35
Rebecca Berens MD: And Right.
38:35
Rebecca Berens MD: Like it, they're, the usage is probably gonna be lower overall than someone who maybe has a parent who is either not engaged or is absent for some other reason.
38:45
Rebecca Berens MD: Yeah.
38:45
Rebecca Berens MD: Or like you said, a lot of these risk taking behaviors are probably associated with an underlying predisposition Yes.
38:52
Rebecca Berens MD: For more risk taking and dopamine seeking behaviors at baseline.
38:55
Rebecca Berens MD: Yes.
38:56
Rebecca Berens MD: So yeah, there's.
38:57
Sonia Singh MD: That's what
38:57
Rebecca Berens MD: it, not necessarily causative here.
38:59
Sonia Singh MD: Yes, I agree.
39:00
Sonia Singh MD: Beyond the mental health side effects, there's also potential physical health side effects.
39:05
Sonia Singh MD: So social media use has been found to correlate with sedentary behavior, lower physical activity, and higher cardiometabolic risk.
39:11
Sonia Singh MD: A lot of people are just laying around.
39:13
Rebecca Berens MD: Yeah.
39:13
Sonia Singh MD: When they're looking at this.
39:14
Rebecca Berens MD: It's a displacement thing again, right?
39:15
Rebecca Berens MD: Like you're talking about if it's displacing sleep, it's also maybe displacing you, walking over to a friend's house.
39:20
Rebecca Berens MD: Yeah.
39:20
Rebecca Berens MD: Or just like even walking around your house.
39:23
Rebecca Berens MD: It doesn't have to be, I'm going to the gym instead of going on social media.
39:26
Rebecca Berens MD: It could just be like normal day to day movement.
39:28
Sonia Singh MD: Other smaller stuff or things like eye strain, musculoskeletal pain, headaches, things like
39:32
Rebecca Berens MD: that.
39:32
Rebecca Berens MD: Tech neck.
39:33
Sonia Singh MD: Yeah.
39:34
Sonia Singh MD: I want to mention briefly before we move on, that there are also studies showing benefits of social media for many users.
39:41
Sonia Singh MD: So some of the potential benefits are like accessing social support, fostering connections, self-expression, community building getting access, or getting connected to mental health resources.
39:52
Sonia Singh MD: So there appears to be when you look at all of the data together, like a U-shaped curve for social media use, where non-users and very heavy users, people at the two extremes are the ones that are most likely to have poor wellbeing, but moderate use can be associated with benefits.
40:09
Sonia Singh MD: So there was a cohort study in Australia, which was huge.
40:12
Sonia Singh MD: It was like over a hundred thousand adolescents, grades four through 12.
40:15
Sonia Singh MD: And by the way, Australia is the first, or I don't know if it's the first, but I know that they've banned social media for children under 16.
40:21
Sonia Singh MD: So like they're very aggressively looking into this.
40:24
Sonia Singh MD: Yeah.
40:24
Sonia Singh MD: And regulating it.
40:25
Sonia Singh MD: So they followed these kids for three years and they saw that moderate social media use was associated with the best wellbeing outcomes while no use and the highest use were associated with poor wellbeing.
40:38
Sonia Singh MD: And these were a little bit different for boys and girls.
40:40
Sonia Singh MD: So for girls, moderate use became favorable in middle adolescents and onwards, and for boys, no use became associated with bad stuff from mid adolescents.
40:51
Sonia Singh MD: And was actually worse than excessive use when you were a late adolescent.
40:58
Sonia Singh MD: Again, I think some of those are like they're self-selecting people out, so for instance if you are a boy and you're middle of high school and you have, you are not on social media at all, is that because you're just not engaging in pro-social behaviors that your peers are engaging in?
41:11
Sonia Singh MD: Is because you're already depressed?
41:13
Sonia Singh MD: Is it because you are socially isolated and, so it's hard to, it's really hard to draw like, conclusions from any of this, but clearly it's showing that even I was surprised to see this, that even among kind of these adolescent populations, there's studies that show there's benefits to wellbeing for some of the reasons I mentioned.
41:30
Rebecca Berens MD: Yeah.
41:31
Rebecca Berens MD: And that's really interesting.
41:33
Rebecca Berens MD: 'cause I do think that my gut reaction is oh my God, no social media,
41:37
Sonia Singh MD: none.
41:37
Sonia Singh MD: Yes.
41:38
Rebecca Berens MD: And that's probably not the right answer either.
41:39
Rebecca Berens MD: And even like I said for myself, like at the beginning, you.
41:44
Rebecca Berens MD: Can you abstain from social media?
41:46
Rebecca Berens MD: Technically yes, but it would actually be really impactful for me to be completely off social media.
41:51
Sonia Singh MD: Yeah.
41:51
Rebecca Berens MD: I think you and I have both had the experience of connecting with a lot of like-minded colleagues and really build, building our practices through what we learned from people on social media
42:02
Sonia Singh MD: Yes.
42:02
Rebecca Berens MD: That we make, like you and I would not have met.
42:04
Sonia Singh MD: Yes.
42:05
Rebecca Berens MD: This
42:05
Sonia Singh MD: podcast would not exist.
42:07
Rebecca Berens MD: And it's not.
42:07
Rebecca Berens MD: And there's so many communities within social media that I would never have had access to or people I would never have met.
42:14
Rebecca Berens MD: Yeah.
42:14
Rebecca Berens MD: Things I would never have learned had I not had that.
42:17
Sonia Singh MD: Yeah.
42:17
Rebecca Berens MD: That would've been really harmful.
42:19
Rebecca Berens MD: Or not allowed me to, have what I now have in terms of friends and family and business connections.
42:24
Rebecca Berens MD: But yeah, it's.
42:26
Rebecca Berens MD: The answer is probably not just cut it all out, but how do we make it safer?
42:30
Sonia Singh MD: We will talk about the answers they're coming up.
42:32
Sonia Singh MD: Okay, so I wanted to talk about another study.
42:34
Sonia Singh MD: So another point I wanna make about this is in a lot of our discussions so far, we're lumping all of these platforms together as one entity, but there's probably varying effects depending on not just who, what person you're talking about, but what platform you're talking about and what type of use they're like, how they're using that platform.
42:52
Sonia Singh MD: So there was one study with a thousand adults where they had them do, and this was like during the peak of the pandemic during quarantine online questionnaires about their social media use.
43:01
Sonia Singh MD: And basically what they found was passive usage of so of Facebook was negatively correlated with wellbeing.
43:08
Sonia Singh MD: And their theory was this was due to upward social comparisons, whereas active use of Instagram was positively related to satisfaction with life and improved negative affect.
43:18
Sonia Singh MD: Through social support was their theory.
43:20
Sonia Singh MD: Active usage of Twitter was positively related to satisfaction with life through social support.
43:25
Sonia Singh MD: Whereas passive usage of Twitter was negatively associated.
43:28
Sonia Singh MD: Again, they theorized due to upward social comparisons.
43:32
Sonia Singh MD: TikTok was apparently not associated with wellbeing in either direction.
43:36
Rebecca Berens MD: Fascinating.
43:36
Sonia Singh MD: Don't believe that.
43:37
Sonia Singh MD: But
43:37
Rebecca Berens MD: yeah, I don't believe that either, but they're fascinating.
43:40
Sonia Singh MD: So anyway that's, this
43:41
Rebecca Berens MD: was, this was early TikTok though.
43:43
Sonia Singh MD: Oh, yes.
43:43
Sonia Singh MD: This was conducted in 2020.
43:45
Rebecca Berens MD: Yeah.
43:45
Sonia Singh MD: Like during the, during.
43:46
Sonia Singh MD: So TikTok,
43:46
Rebecca Berens MD: we need to reassess TikTok.
43:47
Sonia Singh MD: Yeah.
43:48
Sonia Singh MD: Okay.
43:49
Sonia Singh MD: Who will revisit that?
43:50
Rebecca Berens MD: So someone else can do that study and we
43:52
Sonia Singh MD: Okay.
43:52
Sonia Singh MD: But I mentioned that study purely to, to demonstrate that not all the platforms and not engaging in all the platforms in the same way is going to result in the same outcome.
44:01
Rebecca Berens MD: Did you find anything on YouTube?
44:03
Rebecca Berens MD: Because I wonder a lot of I feel like boy, social media use tends to gravitate more to towards YouTube.
44:10
Rebecca Berens MD: YouTube, which is not technically social media, but it is
44:13
Sonia Singh MD: i'm curious.
44:13
Sonia Singh MD: Also YouTube was definitely considered social media and the trial
44:16
Rebecca Berens MD: mentioned.
44:17
Rebecca Berens MD: Okay good.
44:17
Sonia Singh MD: YouTube did not come up as much in these, and you, that's YouTube's biggest defense for the trial is they're like, we're not even a social media company.
44:25
Sonia Singh MD: We are a streaming company.
44:26
Sonia Singh MD: They're just like, don't lump us in.
44:27
We'll
44:27
Rebecca Berens MD: say, turn off your comment section and then you will no longer be social media.
44:31
Sonia Singh MD: So yeah, I don't have any specific data around YouTube, but.
44:34
Sonia Singh MD: Okay, so the next question is, but is there withdrawal or tolerance?
44:37
Sonia Singh MD: 'cause that is one of the features, that we think of with addiction.
44:41
Sonia Singh MD: So there was one study that examined several potentially addictive behaviors including gambling, exercise, social media use, and they tried to identify whether there was any clear withdrawal pattern or pattern of symptoms that emerges when people try to abstain from it.
44:55
Sonia Singh MD: They did not really find any clear pattern for social media use.
44:59
Sonia Singh MD: There was a nice little study with 154 adults around age 30 who were randomized to either abstain from social media for one week or continue to use as usual.
45:08
Sonia Singh MD: And then they were tracked on various measures of anxiety, depression, and overall wellbeing before and after the intervention.
45:14
Sonia Singh MD: And they did see significant improvements in all of those metrics.
45:17
Sonia Singh MD: And I think there was a dose dependent relationship where like.
45:20
Sonia Singh MD: The more you were using initially the bigger the response you had to the intervention or the week of abstinence.
45:26
Sonia Singh MD: But then later there was meta analysis that looked at a few different pooled studies that looked at abstaining from social media.
45:33
Sonia Singh MD: There were 10 that they found and there did not seem to be on the whole a significant positive or negative impact from abstaining from social media.
45:41
Sonia Singh MD: So the data on abstinence from social media is actually not like a slam dunk.
45:45
Sonia Singh MD: Oh, it helps.
45:46
Sonia Singh MD: And I looked at the funding for these studies'cause I was immediately sensitive and they were like public grants and stuff.
45:52
Sonia Singh MD: Okay.
45:52
Sonia Singh MD: So there's nothing there.
45:53
Sonia Singh MD: Okay.
45:53
Rebecca Berens MD: But that's interesting'cause that's one of the criteria,
45:57
Sonia Singh MD: right?
45:57
Sonia Singh MD: So it is one of the criteria, but you don't have to have all of the criteria.
46:01
Rebecca Berens MD: Right.
46:01
Sonia Singh MD: For a substance use disorder.
46:02
Rebecca Berens MD: And I wonder because like I said, when we talked about, my horrific results at the beginning I was pleasantly surprised.
46:08
Rebecca Berens MD: I thought I was gonna have more withdrawal type behaviors.
46:10
Rebecca Berens MD: Yeah.
46:11
Rebecca Berens MD: When I stopped when I put my brick up.
46:12
Sonia Singh MD: Your experience cor correlates with some of these studies, which are like, yeah.
46:15
Sonia Singh MD: There's not really like a clear withdrawal syndrome, cravings and boredom or like the two things that were identified as potential
46:21
Rebecca Berens MD: Yeah.
46:21
Sonia Singh MD: Withdrawal.
46:22
Rebecca Berens MD: But I feel like there is tolerance.
46:24
Sonia Singh MD: Yeah.
46:24
Sonia Singh MD: I would
46:25
Rebecca Berens MD: suspect that, and I, that, that may be harder to study and I don't know that any of these things really address this, but like tolerance, just for anyone listening is like increasing amounts of the same
46:34
Sonia Singh MD: Yeah.
46:35
Rebecca Berens MD: Substance or behavior to get the same effect.
46:37
Rebecca Berens MD: And I do strongly feel there is tolerance.
46:39
Sonia Singh MD: Yeah.
46:40
Rebecca Berens MD: Because I had a complete block on social media for several weeks.
46:45
Rebecca Berens MD: And then I did start reusing Facebook specifically because I just, I have a lot of personal and business uses for Facebook that I was like, I have to use this a little bit.
46:54
Rebecca Berens MD: And I did find that that usage increased substantially.
46:58
Rebecca Berens MD: I was able to first get away with just 10, 10 minutes a day checking in on the couple things that I needed to use it for.
47:03
Rebecca Berens MD: But it's oh, increased over time and that I don't know, I feel like there's tolerance in my n of one
47:08
Sonia Singh MD: I
47:08
Rebecca Berens MD: don't know.
47:08
Rebecca Berens MD: That's the study.
47:08
Rebecca Berens MD: We're n of
47:08
Sonia Singh MD: two.
47:09
Sonia Singh MD: No, we're n of two.
47:09
Sonia Singh MD: 'cause I've had the exact same experience where I was completely off for almost, I think, I don't know, five or six months, like a really long period where I was just completely silent on all of them and was not checking them.
47:19
Sonia Singh MD: And then I did the same thing where I was dipping my toes in just occasionally to do, and initially it was very manageable.
47:25
Sonia Singh MD: I was only doing it on my desk, like not desktop, but only doing it on my computer.
47:29
Sonia Singh MD: And, but then it just, it's a slippery slope.
47:32
Sonia Singh MD: Yeah.
47:32
Sonia Singh MD: And now I'm back to where I was probably a year ago, except I'm not producing much content.
47:38
Sonia Singh MD: I'm just passively consuming
47:39
Rebecca Berens MD: it, which is possibly worse, which is according to studies.
47:41
Rebecca Berens MD: But yeah.
47:42
Rebecca Berens MD: So I also did the same thing where I was like, I'm only gonna use Facebook on my desktop.
47:46
Rebecca Berens MD: I'm gonna have a designated time of day, like this is the time that I go in to do the couple of things that I need to do.
47:52
Rebecca Berens MD: And it was working.
47:52
Rebecca Berens MD: And then I kept Facebook Messenger on
47:55
Sonia Singh MD: my
47:55
Rebecca Berens MD: phone.
47:55
Rebecca Berens MD: Same.
47:56
Rebecca Berens MD: And I found out that you can sneakily access your Facebook feed through Facebook Messenger, even though I had bricked it on the app and I had blocked the website from the browser.
48:06
Rebecca Berens MD: I could still get it.
48:07
Rebecca Berens MD: I was like, this is insane.
48:08
Rebecca Berens MD: I not get to it.
48:09
Sonia Singh MD: Yeah.
48:10
Rebecca Berens MD: Without taking Messenger off.
48:11
Rebecca Berens MD: And Messenger is again, I use it to talk to people.
48:14
Sonia Singh MD: People
48:14
Rebecca Berens MD: Yes.
48:14
Rebecca Berens MD: I know that I wanna talk to,
48:15
Sonia Singh MD: I know
48:16
Rebecca Berens MD: like my brother and I call each other through Facebook Messenger and I have family members in the UK that's how we talk to each other.
48:21
Rebecca Berens MD: I'm just like, this is very frustrating.
48:24
Sonia Singh MD: Okay, so towards the very end here, I have some research on effective interventions that we can
48:31
Rebecca Berens MD: Okay, great.
48:31
Sonia Singh MD: Before we get
48:32
there,
48:32
Rebecca Berens MD: I can't wait to hear that
48:33
Sonia Singh MD: before we get there.
48:34
Sonia Singh MD: Yeah.
48:34
Sonia Singh MD: You're gonna be happy.
48:35
Rebecca Berens MD: Okay.
48:36
Sonia Singh MD: Before we get there, I wanna briefly talk about.
48:38
Sonia Singh MD: Okay, so what do we learn from this as doctors and humans?
48:41
Sonia Singh MD: What conclusions do I draw from all of this research?
48:44
Sonia Singh MD: You know what I would with the bottom line here is I would say right now there's no formal diagnosis here.
48:50
Sonia Singh MD: There's no official diagnostic criteria, there's no formal definition around this.
48:55
Sonia Singh MD: But clearly there is growing evidence that there is an entity of problematic social media use.
49:00
Sonia Singh MD: We may not call it addiction, but we can say at least there's probably something out there that's problematic social media use, it has physiologic effects on us, it has potential harms.
49:09
Sonia Singh MD: We may never really prove causation at this point, just'cause it's becoming so pervasive that I don't know how you would even do an intervention where somebody is completely naive to some of these technologies.
49:22
Sonia Singh MD: And I think as algorithms evolve and get better and better, and we use them more and more, and it becomes harder and harder to stop it, it's just going to be a more challenging thing to really pin down in a scientific way.
49:31
Sonia Singh MD: But.
49:32
Sonia Singh MD: I think anything in excess can be bad.
49:35
Sonia Singh MD: You can over exercise and you can over hydrate and you can do all these things to excess.
49:39
Sonia Singh MD: But I think what's unique about social media and that we need to constantly remind ourselves is that it is designed to work on your brain very, intentionally in that way.
49:50
Sonia Singh MD: And right now the data on stopping our social media use is not really there.
49:55
Sonia Singh MD: But I do think eventually there will be a diagnosis associated with this.
49:59
Sonia Singh MD: And I think once there is a clear definition and diagnosis, then I do think we'll be able to see more data on what the benefits are of treating that diagnosis and having interventions that reduce use.
50:10
Sonia Singh MD: And the other point I wanna make with this is, I was thinking about how, with substance use disorders, there's this spectrum of how functional you can be abusing that substance.
50:18
Sonia Singh MD: For example, meth, it's really hard to be.
50:21
Sonia Singh MD: In the depths of a meth addiction and for it to not impair your life.
50:24
Sonia Singh MD: And for it to not show, whereas with alcohol, you can be a pretty highly functional alcoholic and nobody can know because it's a socially sanctioned thing that people use.
50:32
Sonia Singh MD: Yeah.
50:32
Sonia Singh MD: And oftentimes you can avoid visible effects of it.
50:36
Sonia Singh MD: And I think social media is even further in that category where the harms of it are, emotional and cognitive and in the displacement of other things.
50:44
Sonia Singh MD: Yeah.
50:44
Sonia Singh MD: And so often it's very easy to mask and to not have any outward signs of it.
50:50
Sonia Singh MD: Like you and I are highly functional people,
50:52
Rebecca Berens MD: arable.
50:53
Rebecca Berens MD: But Sure.
50:53
Sonia Singh MD: I think, we're professionals and we run businesses and we have small children and we,
50:58
Rebecca Berens MD: we appear functional.
50:59
Sonia Singh MD: We show up on time for stuff, you we're functioning right.
51:03
Sonia Singh MD: But I think our level of social media use and addiction would have to get.
51:08
Sonia Singh MD: Pretty extreme.
51:09
Sonia Singh MD: Yeah.
51:09
Sonia Singh MD: Before it would be visibly impairing us, but I don't know, I notice that I'm not going to bed when I should go to bed.
51:15
Sonia Singh MD: And that, my brain feels like it's rotted, like
51:19
Rebecca Berens MD: Yeah.
51:19
Sonia Singh MD: I don't know.
51:20
Sonia Singh MD: So I think it's something where it's just not as visible of a, of an issue.
51:25
Sonia Singh MD: And so it might take a longer time.
51:27
Sonia Singh MD: It's already taken us a long time with alcohol, so it might take an even longer time with something like that.
51:31
Rebecca Berens MD: And it is hard to study also.
51:33
Rebecca Berens MD: 'cause I think the other harm that I don't think we really talked about as much in this episode, but we've referred to a lot in other times is larger societal polarization.
51:41
Sonia Singh MD: Oh
51:41
Rebecca Berens MD: and that's so hard to study.
51:44
Rebecca Berens MD: 'cause when you're polarized, you like, don't buy into it, I don't know.
51:48
Rebecca Berens MD: But I think that, I think it would be hard to find someone who didn't agree that social media has contributed to polarization.
51:55
Sonia Singh MD: Yeah.
51:56
Rebecca Berens MD: But it's very hard to prove.
51:58
Rebecca Berens MD: Yeah.
51:59
Rebecca Berens MD: And study, but that is a larger societal harm that's not individual.
52:03
Rebecca Berens MD: And yeah it's just, it's
52:04
Sonia Singh MD: such a tricky, we show a separate episode on that.
52:06
Rebecca Berens MD: Yes.
52:06
Sonia Singh MD: Because it, like on ra, on polarization and radicalization
52:09
Rebecca Berens MD: Yes.
52:10
Sonia Singh MD: Like how the design of the algorithm basically pushes you towards those extremes, you
52:14
Rebecca Berens MD: know?
52:14
Rebecca Berens MD: Yeah.
52:14
Rebecca Berens MD: Yeah.
52:15
Rebecca Berens MD: That could be a whole conversation.
52:16
Sonia Singh MD: That's true.
52:16
Sonia Singh MD: That did not come up as much in the kind of the research around general harms.
52:20
Sonia Singh MD: Yeah.
52:20
Sonia Singh MD: Actually it's interesting that wasn't even mentioned.
52:21
Sonia Singh MD: 'cause I think that's a really, I think it's
52:22
Rebecca Berens MD: to
52:22
Sonia Singh MD: study new phenomenon too.
52:23
Sonia Singh MD: Yeah.
52:24
Rebecca Berens MD: But it's hard to study.
52:24
Sonia Singh MD: Yeah.
52:25
Rebecca Berens MD: Because there's so many things that influence someone's, Beliefs system.
52:29
Rebecca Berens MD: Yeah.
52:29
Rebecca Berens MD: You can't be like, oh, it's all'cause of social media.
52:31
Rebecca Berens MD: But I think we could all say it's definitely partially because of social media.
52:35
Sonia Singh MD: Yes.
52:35
Rebecca Berens MD: I think we all intrinsically know that, but it's hard to prove it scientifically yeah.
52:40
Sonia Singh MD: So anything else you wanna say in terms of what you take from this or what you learned from this?
52:44
Rebecca Berens MD: No, I think, I think I, I felt a lot of this intrinsically and I felt, I'm glad there's some evidence behind it.
52:51
Sonia Singh MD: Yeah.
52:51
Rebecca Berens MD: And yeah.
52:52
Rebecca Berens MD: And now I just wanna know how can we fix it?
52:54
Rebecca Berens MD: 'cause I personally need to know.
52:55
Rebecca Berens MD: Yeah.
52:55
Rebecca Berens MD: And then, yeah, I do think it's important to be able to talk about this from a very scientific perspective with patients.
53:00
Rebecca Berens MD: Yeah.
53:00
Rebecca Berens MD: Because it is a hard topic to broach also.
53:02
Sonia Singh MD: Yeah.
53:02
Sonia Singh MD: Yeah.
53:03
Rebecca Berens MD: Yeah.
53:03
Sonia Singh MD: So how would we talk about this with our patients and how does this information change our practice?
53:07
Sonia Singh MD: So I would say like just talking to patients about their social media use.
53:12
Sonia Singh MD: How much, how often, how are you feeling about it?
53:14
Sonia Singh MD: Have you wanted to cut back?
53:16
Sonia Singh MD: Have you tried to cut back?
53:17
Sonia Singh MD: We did a few episodes on fitness trackers and all the data those give, but sometimes I'm like, I would be curious to see your screen time and your app usage.
53:25
Sonia Singh MD: That might tell me a lot about what's going on with your
53:27
Rebecca Berens MD: help.
53:28
Rebecca Berens MD: See that was actually the thing that when I saw mine, I was most horrified by that prompted me to get the brick.
53:33
Sonia Singh MD: cause
53:33
Rebecca Berens MD: I find that's how it affects me is it's not that, it's just the time just evaporates.
53:38
Rebecca Berens MD: And I'm like, I went on here to do a specific thing.
53:40
Sonia Singh MD: Yes.
53:40
Rebecca Berens MD: And it's 30 minutes later.
53:41
Rebecca Berens MD: How did I end up here?
53:43
Sonia Singh MD: Yes.
53:43
Rebecca Berens MD: Yeah.
53:43
Rebecca Berens MD: Oh my gosh.
53:44
Rebecca Berens MD: I do wanna see that because I did start asking about it.
53:46
Rebecca Berens MD: I think we both around the same time.
53:47
Sonia Singh MD: I
53:47
Rebecca Berens MD: can't remember why we both added it to our intake forms.
53:50
Sonia Singh MD: Yes.
53:50
Rebecca Berens MD: And so the conversation does come up, but yeah, it's what do you do with that information?
53:54
Sonia Singh MD: Yes.
53:54
Sonia Singh MD: Okay.
53:54
Sonia Singh MD: So that's the next question.
53:55
Sonia Singh MD: So how do we, what do we tell them?
53:58
Sonia Singh MD: How do we decrease, use effectively, what interventions work for that?
54:01
Sonia Singh MD: So as with most things, a multifaceted approach is the most effective, a combination of approaches.
54:07
Sonia Singh MD: So step number one is screen for underlying disorders like anxiety, depression, A DHD.
54:13
Sonia Singh MD: So like we talked about, there's a bi-directional relationship with some of these things.
54:16
Sonia Singh MD: So you don't wanna miss, you can't.
54:17
Sonia Singh MD: Blame everything on the social media.
54:19
Sonia Singh MD: You wanna miss an underlying diagnosis that we have effective treatments for.
54:22
Sonia Singh MD: So screen for those things and treat them.
54:24
Sonia Singh MD: In terms of therapeutic approaches, CBT and things similar to CBT, like mindfulness based interventions and self-compassion based interventions seem to be highly effective in reducing social media use.
54:38
Sonia Singh MD: Because they address some of the root causes in terms of what someone's personal motivation is and why they're going to social media in the first place.
54:45
Sonia Singh MD: So it helps them limit use or engage in a more healthy way.
54:49
Sonia Singh MD: So an example of that, mindfulness based interventions was when example, under that umbrella of CBT strategies and it encourages patients to be more intentional with their uses, examine their motive for using, and then, basically reframe some of those thoughts that lead them to use from being self-critical to being more, compassionate and non-judgmental towards themselves.
55:10
Sonia Singh MD: Incorporating breathing exercises and compassionate self-talk to limit usage.
55:15
Sonia Singh MD: And there were a few small studies on digital detox apps.
55:18
Sonia Singh MD: So not the brick, which is a different technology, but like the app I mentioned, clear space that my husband uses and similar type apps.
55:24
Sonia Singh MD: And they have been shown to reduce the overall time spent.
55:28
Sonia Singh MD: But my guess would be that with those things, those can all be short term strategies, but if you're really motivated to keep using it and you have not addressed maybe some of those underlying motivators, you might come back to it.
55:40
Rebecca Berens MD: And that's why I got the brick because yeah, the, you have to have the physical object and if the object is in my house and I am not, I can't undo it.
55:49
Rebecca Berens MD: And that's the thing with so many of these apps, you can override them.
55:52
Sonia Singh MD: I'm curious if you ever find yourself binging once you get back to the brick.
55:56
Rebecca Berens MD: No.
55:57
Rebecca Berens MD: So it's actually interesting.
55:58
Rebecca Berens MD: I un bricked myself.
56:00
Rebecca Berens MD: Somewhat recently because I needed to share a story from someone for a podcast episode I did.
56:08
Rebecca Berens MD: And I couldn't do it from the desktop.
56:10
Rebecca Berens MD: So I had to go in to Instagram and share this story, and so I unb bricked it and I truly just forgot, and I haven't gone back on Instagram.
56:18
Rebecca Berens MD: Oh.
56:18
Rebecca Berens MD: Even though I am un bricked, which now I've spoken it into existence, I'll probably do it.
56:22
Rebecca Berens MD: Okay.
56:22
Rebecca Berens MD: So I'll go brick myself.
56:23
Rebecca Berens MD: You're
56:23
Sonia Singh MD: having a craving right now.
56:24
Rebecca Berens MD: But but yes I was like, oh, this is great.
56:27
Rebecca Berens MD: But like I said, with Facebook, I have really struggled because I have some things that I do feel, I quote unquote, legitimately use it for that I do really think are legitimate.
56:36
Rebecca Berens MD: And I do find that that sort of tolerance effect, like once I'm in, I just keep
56:39
Sonia Singh MD: Yes.
56:39
Rebecca Berens MD: Keep going.
56:40
Rebecca Berens MD: So it's, I wouldn't say it's like what you're alluding to is oh, if you cut yourself off completely are you gonna then binge once it comes back?
56:46
Rebecca Berens MD: I haven't had that experience with Instagram, which has been great, but but yeah.
56:50
Sonia Singh MD: That's good to know.
56:51
Sonia Singh MD: Yeah.
56:51
Sonia Singh MD: I guess so.
56:52
Sonia Singh MD: Yes.
56:52
Sonia Singh MD: You don't binge when you come back, but like you said, there's a, there's you then have reset your tolerance and then it starts increasing again.
56:59
Sonia Singh MD: Which I feel like I have the same experience where for a long time I was being really good about only going to Facebook when I had an actual intention Yes.
57:06
Sonia Singh MD: Of I have to do this thing, or I have to post in this group, or I have to do whatever.
57:10
Sonia Singh MD: And now I'm totally back to my baseline, which is get bored, open it.
57:15
Sonia Singh MD: Nothing interesting.
57:16
Sonia Singh MD: Okay.
57:17
Sonia Singh MD: Lame didn't get a, didn't get a dopamine hit from that.
57:19
Sonia Singh MD: And then an hour later I'll look at it again and then there'll be something interesting and I'm like this was really interesting.
57:24
Sonia Singh MD: And then I'm like I gotta keep looking because no matter what the outcome, you just are motivated to keep going to it.
57:30
Rebecca Berens MD: That's a variable response
57:31
Sonia Singh MD: training.
57:32
Sonia Singh MD: It's just, it's crazy.
57:33
Sonia Singh MD: Anyway, okay.
57:34
Sonia Singh MD: So digital detox apps do seem to work CBT and CBT based strategies, including mindfulness based intervention, self-compassion interventions.
57:41
Sonia Singh MD: Those seem to work.
57:43
Sonia Singh MD: One document that I really liked around this was a p has a whole, like all these recommendations around digital hygiene and raising children in a digital world.
57:52
Sonia Singh MD: And I was reading these and I wanted to like, I felt like I was at a spoken word and I wanted to snap.
57:55
Sonia Singh MD: I wanted to snap for them.
57:56
Sonia Singh MD: I was just like, yes.
57:58
Sonia Singh MD: Preach a p.
57:58
Sonia Singh MD: This is amazing.
58:00
Sonia Singh MD: So they're of the attitude that this is the ecosystem our children are growing up in.
58:04
Sonia Singh MD: This is the world now and abstinence is going to be really challenging.
58:07
Sonia Singh MD: And if you think about, a teenager who every single friend of theirs is on social media Yeah.
58:13
Sonia Singh MD: And you're telling them you are not going to be there can be a social isolation to that, yeah.
58:17
Sonia Singh MD: Like that.
58:17
Sonia Singh MD: There is potential harm in that too.
58:19
Sonia Singh MD: So their attitude is really about teaching children digital literacy.
58:23
Sonia Singh MD: And this is around children, but I think this is an approach we can take with our adult patients too.
58:27
Sonia Singh MD: I don't see why it doesn't apply.
58:29
Sonia Singh MD: So they go through all of these different there's a big table that includes more things than just social media.
58:34
Sonia Singh MD: They talk about screens in general, but I just highlighted the ones that are related to social media.
58:39
Sonia Singh MD: So when talking about automated algorithms, they suggest teach children about algorithms and talk about why they might be seeing specific content online, talk about recommendation feeds and why they might be showing specific videos.
58:50
Sonia Singh MD: So they're referring to teaching them, why they might see really scary stuff a lot.
58:54
Sonia Singh MD: Not because scary stuff happens a lot, but because that's, you can argue that it does, but you know that it may make you perceive that these things are happening all the time, but they're not, it's just that's what the algorithm wants to show you, right?
59:05
Sonia Singh MD: Yeah.
59:06
Sonia Singh MD: They also talk about big system level changes we can make, which is like creating regulatory frameworks and processes for protecting youth from these design features.
59:13
Sonia Singh MD: Holding companies accountable for manipulative algorithms that amplify harmful content.
59:19
Sonia Singh MD: So that's around the algorithms around engagement prolonging design.
59:22
Sonia Singh MD: So those are things like auto play and infinite scroll.
59:25
Sonia Singh MD: They say ask about how children decide when they're done with digital media.
59:28
Sonia Singh MD: Talk about digital design features that make it hard for them to stop.
59:32
Sonia Singh MD: So educate them about the fact that oh, you know how this video just.
59:35
Sonia Singh MD: Plays we're gonna set it now to not autoplay, so that you can think about which video you wanna watch or if you're done provide resources for families on how to turn off autoplay on streaming video platforms, turn it off at night, set it to not autoplay, et cetera.
59:48
Sonia Singh MD: For misinformation.
59:49
Sonia Singh MD: They say pediatric providers and caregivers might teach and reflect on the quality of information, how to evaluate sources and what underlying video and content motives might be.
59:57
Sonia Singh MD: So when I read those I was I feel like that's what we're doing with this podcast.
1:00:01
Sonia Singh MD: Yeah.
1:00:01
Rebecca Berens MD: Well, specifically the misinformation one for sure.
1:00:03
Rebecca Berens MD: That's our whole point.
1:00:04
Rebecca Berens MD: But yeah, I think the part that's frustrating for me is we can do everything we can do, but it does still require, there needs to be a setting we can turn off to stop the auto plate.
1:00:14
Rebecca Berens MD: And there's so many settings that are so hidden and so I don't even know what they all are.
1:00:19
Rebecca Berens MD: It should be easier to just be like, make this less, less addictive.
1:00:24
Rebecca Berens MD: Yeah.
1:00:24
Rebecca Berens MD: And let me still use it, Like I have my notifications turned off on my phone, so I don't see the little red thing to make me wanna click on it.
1:00:29
Rebecca Berens MD: All those sorts of things.
1:00:30
Rebecca Berens MD: It's so difficult Yeah.
1:00:32
Rebecca Berens MD: To use these safeguards.
1:00:34
Rebecca Berens MD: It should be easier.
1:00:35
Rebecca Berens MD: Yeah.
1:00:35
Rebecca Berens MD: And that's where maybe that regulatory stuff comes in, but it's like we are all individually fighting this really difficult battle.
1:00:40
Rebecca Berens MD: It would be so nice if the companies would just make it a little bit easier for us.
1:00:45
Rebecca Berens MD: And rather than, claiming that there's no problem and this is user error, yeah.
1:00:50
Rebecca Berens MD: It's it's obviously not,
1:00:53
Sonia Singh MD: but but you're also speaking from the perspective of somebody who is aware of the harms and actively trying to limit use and I think there is a huge percentage of the population that has not even faced the fact that this might be harming us.
1:01:07
Rebecca Berens MD: Yes.
1:01:08
Rebecca Berens MD: Yeah.
1:01:08
Sonia Singh MD: I, I think a lot of people haven't even.
1:01:10
Sonia Singh MD: Like I said, like patients will come in saying, I'm not sleeping enough.
1:01:13
Sonia Singh MD: Like I have brain fog, and social media is nowhere on the, their mind about potential root causes of that, so I think, step one is just awareness, raising awareness about the fact that this is a problem.
1:01:26
Sonia Singh MD: Oh, I had another thought on that.
1:01:27
Sonia Singh MD: Oh, okay.
1:01:28
Sonia Singh MD: I was gonna say, one of my dreams now that I've decided is to have a digital detox day.
1:01:34
Rebecca Berens MD: Oh my gosh.
1:01:34
Sonia Singh MD: How, first of all, first I was just thinking of this on a, for my practice or for you.
1:01:39
Sonia Singh MD: And I could do it.
1:01:39
Sonia Singh MD: We could do I was
1:01:40
Rebecca Berens MD: gonna say, when we, when can we do
1:01:41
Sonia Singh MD: that?
1:01:41
Sonia Singh MD: We could schedule it.
1:01:43
Sonia Singh MD: Yes.
1:01:43
Sonia Singh MD: We could schedule it a digital detox day where we ceremoniously, delete all of our social media apps from our phone and we go on an unsubscribing spree for emails.
1:01:53
Sonia Singh MD: 'cause I just get so many stupid, like Old Navy and random stuff that I'm like, I don't need to know when there's a silly old baby.
1:02:00
Sonia Singh MD: Unsubscribe from lists, turn off notifications.
1:02:02
Sonia Singh MD: We could find all of turn off auto plays, set every restrictive setting that we can set on, all of the apps that we do use to just reduce alert fatigue.
1:02:11
Rebecca Berens MD: Yes.
1:02:12
Rebecca Berens MD: Yes.
1:02:12
Sonia Singh MD: The alert fatigue that we're having.
1:02:14
Sonia Singh MD: And then I was thinking like, wouldn't it be fun if that was just like a national day where everybody was
1:02:19
Rebecca Berens MD: yes.
1:02:19
Rebecca Berens MD: Digital detox
1:02:20
Sonia Singh MD: day.
1:02:20
Sonia Singh MD: Yes.
1:02:20
Sonia Singh MD: A digital detox day.
1:02:22
Sonia Singh MD: The way people, in certain religious communities fast.
1:02:25
Sonia Singh MD: It would be a digital fasting day where it was like, okay, everyone's gonna put down their phones and try to be non-online humans.
1:02:32
Rebecca Berens MD: Yeah.
1:02:32
Rebecca Berens MD: Because I'm sure you have this experience too, I'm sure like we both are on call all the time.
1:02:37
Sonia Singh MD: Yeah.
1:02:37
Rebecca Berens MD: 'Cause one thing that I've tried to think about doing is just like when I get home, just put my phone in my room away, on the charger away from me, and then I just live my life.
1:02:47
Rebecca Berens MD: But it's like, what if a patient calls
1:02:49
Sonia Singh MD: me?
1:02:49
Sonia Singh MD: I know.
1:02:49
Sonia Singh MD: Yeah.
1:02:50
Rebecca Berens MD: And that's even with something like this, I'm like, what if a patient calls me?
1:02:52
Rebecca Berens MD: I need to be available for the patient to get ahold of me.
1:02:56
Rebecca Berens MD: And that is one of the things that makes it so hard for me to not
1:03:00
Sonia Singh MD: be I'm sure a lot of parents would say that too.
1:03:02
Sonia Singh MD: I feel that way about the gym when I go to the gym.
1:03:03
Sonia Singh MD: A lot of other women, I will see them not take their phones.
1:03:06
Sonia Singh MD: And I always take my phone because I'm like, I don't know, something could happen.
1:03:09
Sonia Singh MD: What if my son's
1:03:10
Rebecca Berens MD: school called when I have
1:03:11
Sonia Singh MD: school?
1:03:12
Sonia Singh MD: Sorry, I was at the gym.
1:03:13
Sonia Singh MD: I just, I feel like there's a lot of fear with being completely disconnected.
1:03:17
Rebecca Berens MD: Yeah.
1:03:18
Rebecca Berens MD: And that's, it's so interesting'cause even when we were kids, there was the home phone attached to the wall.
1:03:24
Sonia Singh MD: Yes.
1:03:24
Rebecca Berens MD: And he was just like, anything could have happened to you.
1:03:27
Rebecca Berens MD: And who would know?
1:03:28
Rebecca Berens MD: And he would've just figured it out.
1:03:30
Rebecca Berens MD: And we probably would be fine.
1:03:32
Rebecca Berens MD: The patient thing is hard because that's a liability,
1:03:34
Sonia Singh MD: yeah.
1:03:35
Sonia Singh MD: That's true.
1:03:35
Sonia Singh MD: It's a
1:03:36
Rebecca Berens MD: job expectation, it just, it's just, it's the expectation now.
1:03:40
Rebecca Berens MD: And that's part of the problem is you're expected to be available and be connected.
1:03:44
Rebecca Berens MD: And to be disconnected, it's seen as negligence.
1:03:48
Sonia Singh MD: Yeah.
1:03:48
Rebecca Berens MD: And it would be probably prosecuted as negligence,
1:03:51
Sonia Singh MD: right.
1:03:51
Rebecca Berens MD: For medical malpractice reasons
1:03:53
Sonia Singh MD: for us.
1:03:54
Sonia Singh MD: Because that is the standard now,
1:03:54
Rebecca Berens MD: right?
1:03:55
Sonia Singh MD: Yeah.
1:03:55
Rebecca Berens MD: And so like it, that's I think the other thing, like there also needs to be a societal shift where we do not expect to just be able to immediately reach someone.
1:04:02
Rebecca Berens MD: We have other safeguards in place to handle situations.
1:04:07
Sonia Singh MD: See, that sounds all good.
1:04:08
Sonia Singh MD: And feeling,
1:04:08
Rebecca Berens MD: I know it's not gonna happen,
1:04:09
Sonia Singh MD: but I one time my aunt came to pick me up at the airport without her cell phone and I was just so enraged.
1:04:16
Sonia Singh MD: How could you?
1:04:17
Sonia Singh MD: And she was like you know what I look like and you know what my, I know what you look like, you know my car.
1:04:21
Sonia Singh MD: And I was like, but I needed to be able to call you and know where you were.
1:04:25
Sonia Singh MD: And even that I just could not handle it.
1:04:27
Sonia Singh MD: So the idea of just not having, I don't know.
1:04:30
Rebecca Berens MD: When I was in high school, so I was 16, my cousin was 18 and we went on a trip together to Spain, just us.
1:04:37
Rebecca Berens MD: There were none of our parents were with us.
1:04:38
Rebecca Berens MD: We went to Spain.
1:04:40
Rebecca Berens MD: We had a great time.
1:04:41
Rebecca Berens MD: Neither one of us had a cell phone.
1:04:42
Rebecca Berens MD: And I was talking about with this, with my mom recently, and she was like, I can't believe I let you do that.
1:04:47
Sonia Singh MD: Yes.
1:04:47
Rebecca Berens MD: When I tell people that I did that in when I was 16, people are like, what?
1:04:51
Rebecca Berens MD: That's insane.
1:04:52
Rebecca Berens MD: And nowadays, people wouldn't even let their kids do that.
1:04:55
Rebecca Berens MD: Even if they would have a cell phone Yes.
1:04:56
Rebecca Berens MD: To be able to get in touch with them.
1:04:58
Rebecca Berens MD: And even in college, I, in summers, I would go home to Scotland and I would work.
1:05:02
Rebecca Berens MD: I worked at my dad's company in just doing some office work for them.
1:05:06
Rebecca Berens MD: And and I didn't have I had a cell phone, but it didn't work there.
1:05:09
Rebecca Berens MD: 'Cause it was before the time of your phone inter all over the world.
1:05:12
Rebecca Berens MD: Inter, yeah.
1:05:12
Rebecca Berens MD: And I just was out and about doing whatever, going wherever, no way of contacting anyone.
1:05:19
Rebecca Berens MD: And it was fine.
1:05:20
Rebecca Berens MD: And I think we also need to let go a little bit.
1:05:23
Sonia Singh MD: Yeah.
1:05:23
Rebecca Berens MD: But.
1:05:24
Rebecca Berens MD: That.
1:05:25
Rebecca Berens MD: Yeah, that's a pipe dream.
1:05:26
Rebecca Berens MD: 'cause I think it's just so culturally unacceptable to not be able to just be in contact with people all the time.
1:05:31
Rebecca Berens MD: Yeah.
1:05:31
Rebecca Berens MD: But there was a time when we did it and it wasn't that long ago.
1:05:34
Rebecca Berens MD: And I think it's important that we try to get back in a little bit.
1:05:39
Sonia Singh MD: I think the bottom line here is just that these technologies are here to stay full abstinence from them is realistically very challenging for a number of reasons.
1:05:50
Sonia Singh MD: And so the right approach and the best we can really do is increase our digital literacy and digital hygiene and learn, which, hopefully this is learnable.
1:06:02
Sonia Singh MD: Learn how to use these platforms in a healthier, more moderated way.
1:06:08
Sonia Singh MD: And I think pushing back on a systemic level, with regulations that kind of limit the exposure of vulnerable parties like children.
1:06:15
Rebecca Berens MD: Yeah.
1:06:16
Sonia Singh MD: To some of these.
1:06:16
Rebecca Berens MD: And because it is very clear that this is intentional.
1:06:20
Sonia Singh MD: Yes.
1:06:20
Rebecca Berens MD: On the part of the companies.
1:06:21
Rebecca Berens MD: Yes.
1:06:21
Rebecca Berens MD: Like a judge just found that, right?
1:06:23
Sonia Singh MD: Yes.
1:06:23
Sonia Singh MD: Yes.
1:06:23
Rebecca Berens MD: And it's not just my personal opinion, the judge also agreed with me.
1:06:27
Rebecca Berens MD: And and there's been numerous w whistleblowers about it.
1:06:30
Rebecca Berens MD: And I think that does need to be something that is taken very seriously and and I hope that now it will be.
1:06:36
Rebecca Berens MD: Yeah.
1:06:36
Rebecca Berens MD: But there's been this,
1:06:37
Sonia Singh MD: yeah.
1:06:37
Sonia Singh MD: I listened to I think the Daily or one of these podcasts had the CEO of YouTube, I might be using the wrong word.
1:06:44
Sonia Singh MD: CEOI think it's the CEO of YouTube.
1:06:46
Sonia Singh MD: But his argument was all of those features are there to enhance the user experience.
1:06:51
Sonia Singh MD: And if they're causing the person to use the platform for more time, that is evidence to them that the platform is giving them more value.
1:07:00
Sonia Singh MD: That is enriching their lives to the point that they want to keep using it beyond whatever other things they could be doing.
1:07:05
Rebecca Berens MD: Oh my God.
1:07:05
Rebecca Berens MD: Massive eyeball.
1:07:06
Sonia Singh MD: I think the more we can just keep reevaluating whether it is adding value and whether it is enriching and you know what it is, displacing, then we can really, hopefully push back on that argument that's not actually the case.
1:07:20
Rebecca Berens MD: I think if that's the, if that's their argument, then let's make them opt in, not opt out.
1:07:25
Rebecca Berens MD: If those are additional features you can offer to make us.
1:07:28
Rebecca Berens MD: Value the use of the platform more.
1:07:31
Sonia Singh MD: Yeah.
1:07:31
Rebecca Berens MD: Let us choose to do that.
1:07:33
Rebecca Berens MD: Yeah.
1:07:33
Sonia Singh MD: Don't
1:07:33
Rebecca Berens MD: make that the default.
1:07:34
Rebecca Berens MD: 'cause even there's an app that nextdoor and I don't know if you, if I have, you're on the Nextdoor app.
1:07:39
Rebecca Berens MD: I hate it and
1:07:40
Sonia Singh MD: I hate it too.
1:07:41
Sonia Singh MD: I don't know how to turn off the notification.
1:07:42
Rebecca Berens MD: So exactly.
1:07:43
Rebecca Berens MD: Because I have actually multiple times gone in and unsubscribed from all emails and they keep adding new ones
1:07:49
Sonia Singh MD: Yes.
1:07:50
Rebecca Berens MD: That I have to go and unsubscribe to.
1:07:51
Rebecca Berens MD: Yes.
1:07:51
Rebecca Berens MD: They're doing it all the time.
1:07:52
Rebecca Berens MD: And I know these platforms are also doing it where you've turned off all the features, but then they add a new feature and now you have to go find where to turn off that feature.
1:07:59
Rebecca Berens MD: And I'm like, just, I will decide if I want the new feature.
1:08:02
Sonia Singh MD: Yeah, I literally have the exact same problem with Nextdoor and then sometimes it'll be like a really juicy it'll be like an assault has happened quite two miles from your home.
1:08:11
Sonia Singh MD: And I'm like, oh my God, what happened?
1:08:12
Sonia Singh MD: But then I like have deleted the app and I forgot my password, so now I can't even read any of it.
1:08:17
Sonia Singh MD: And then you
1:08:17
Rebecca Berens MD: can't, but you also can't turn off the notification.
1:08:19
Sonia Singh MD: Yes.
1:08:19
Sonia Singh MD: So it's just filling up my inbox and making me anxious.
1:08:22
Sonia Singh MD: Yeah.
1:08:22
Rebecca Berens MD: Drives you crazy
1:08:22
Sonia Singh MD: about
1:08:22
Rebecca Berens MD: burglaries.
1:08:24
Rebecca Berens MD: Do I unsubscribe from you and you just keep subscribing me to new list?
1:08:28
Rebecca Berens MD: It drives you crazy.
1:08:29
Sonia Singh MD: Yeah.
1:08:29
Sonia Singh MD: Anyway, that's the story with social media addiction.
1:08:33
Sonia Singh MD: I hope you feel better.
1:08:36
Rebecca Berens MD: No one feels better, but we are maybe encouraged that there's something we can do about it and that now maybe there is some, incentive for the companies to help us.
1:08:46
Sonia Singh MD: Yeah.
1:08:47
Rebecca Berens MD: Not
1:08:47
Sonia Singh MD: make
1:08:47
Rebecca Berens MD: this so difficult.
1:08:48
Sonia Singh MD: Yeah, maybe the tides will turn.
1:08:49
Sonia Singh MD: So anyway, if you want a full summary of our conversation today, you can find it on our substack.
1:08:55
Sonia Singh MD: You can find that@theantisocialdoctors.com.
1:08:58
Sonia Singh MD: In that we also include our antidote, which is little affirmations for you to remind yourself around this topic as well as some scripting that might be helpful for clinicians who wanna talk to their patients about social media.
1:09:09
Sonia Singh MD: And the Substack Post also will include all of the references.
1:09:13
Sonia Singh MD: There are a ton for this episode.
1:09:15
Sonia Singh MD: So if you're interested in delving a little deeper into some of these studies and looking at the data yourself, that's where you can find it.
1:09:20
Sonia Singh MD: Okay, so thanks for joining us.
1:09:23
Rebecca Berens MD: Yeah, thanks Sonya.
1:09:24
Sonia Singh MD: Hey, guys.
1:09:25
Sonia Singh MD: Last but not least, we have a very important disclaimer.
1:09:28
Sonia Singh MD: This podcast is intended for educational and entertainment purposes only.
1:09:33
Sonia Singh MD: The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation, diagnosis, or treatment.
1:09:47
Sonia Singh MD: Listening to this podcast does not establish a physician-patient relationship between you and the hosts.
1:09:52
Sonia Singh MD: We are doctors, but not your doctors.
1:09:55
Sonia Singh MD: Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances.
1:10:02
Sonia Singh MD: Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health.
1:10:07
Sonia Singh MD: Medical conditions or treatment options, never disregard or delay medical advice because of something you've heard on this podcast.
1:10:15
Sonia Singh MD: While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated, although we do our best to stay up to date.
1:10:28
Sonia Singh MD: Please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions.
1:10:35
Sonia Singh MD: Medicine is not static and information may change over time.
1:10:39
Sonia Singh MD: We, the hosts make no guarantees about the accuracy, completeness, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors Podcast, you have agreed to these terms.
1:10:55
Sonia Singh MD: Thanks again for joining us.