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Screen Addiction (PIMU) with Dr. Bushra Rizwan - Episode 1 · Mind & Medicine - A Behavioral Health Podcast by Sentara

• 0:00
  Speaker 1: Hello and welcome to Mind and Medicine, a Sentara podcast. I'm Tommy Bateman, your host, and today we will be meeting with Dr Bushra Rizwan to talk about PIMU or screen addiction. But before we begin, some important CME announcements. This episode is accredited for AMA PRA Category 1 credits. For full accreditation, designation, and disclosure information, please refer to the show notes and now the show. Hello, Dr.
• 0:33
  Speaker 1: Rizwan.
• 0:34
  Speaker 1: Thank you for joining us today.
• 0:36
  Speaker: Thank you for having me.
• 0:37
  Speaker 1: Absolutely.
• 0:38
  Speaker 1: And before we get started, uh tell us about yourself and your background and how you got into screen addiction to begin with.
• 0:46
  Speaker: Sure.
• 0:46
  Speaker: So I'm a child and adolescent psychiatrist.
• 0:49
  Speaker: I've recently started with Sentara.
• 0:51
  Speaker: And prior to my role here at Sentara, I was an assistant professor at Johns Hopkins Hospital in Baltimore, Maryland.
• 0:59
  Speaker: Throughout my fellowship and training in child and adolescent psychiatry, I became interested in substance use research.
• 1:08
  Speaker: And that led to exploring and looking at screen addiction as an area of interest.
• 1:16
  Speaker 1: Wonderful.
• 1:17
  Speaker 1: Thank you for that.
• 1:18
  Speaker 1: So explain to me.
• 1:19
  Speaker 1: Clinically speaking, what is screen addiction?
• 1:22
  Speaker 1: It's got to be more than just that kid watches too much TV.
• 1:26
  Speaker: Sure.
• 1:26
  Speaker: We try to stay away from the term screen addiction in clinical practice.
• 1:31
  Speaker: Even though we may use it in research, we try to stay away from that term just because of the stigma.
• 1:37
  Speaker: So that term is when we when we talk about clinically, that term we we call it problematic media use or problematic interactive media use, short for Pimu.
• 1:48
  Speaker: And a lot of stigma around the term addiction.
• 1:56
  Speaker: So we try to stay away from screen addiction per se as a as a term that we use in clinical practice.
• 2:02
  Speaker: And what that looks like is impairment in functioning.
• 2:07
  Speaker: So when someone comes in and I hear things like they're not sleeping well, their grades are declining, they're not functioning at home and at school, that's when I that's when red flags come up and then I ask more questions.
• 2:21
  Speaker: And I can go over some of the things that I kind of look for or ask in sessions.
• 2:27
  Speaker 1: Thanks.
• 2:27
  Speaker 1: And just to clarify, uh Pimu is just like any other uh uh diagnosis in that it needs to have an impact on your life in some sort of way, like social work or uh any other thing, because everybody uses the screen too much, everybody eats too much, everybody feels sad and blue.
• 2:45
  Speaker 1: That doesn't necessarily mean that you're uh getting diagnosed with a disorder.
• 2:50
  Speaker 1: Is that the same for here?
• 2:52
  Speaker: That is correct, yes.
• 2:53
  Speaker: Um, so we see, you know, we look for uh we go off of the screen addiction research, and and because um there's a lot of similarities and parallels there, um we do see, you know, loss of control.
• 3:05
  Speaker: For example, um, you know, a child is on the device for hours at a time.
• 3:10
  Speaker: Um, they cannot stop the behavior, they're constantly on there.
• 3:13
  Speaker: It's becoming kind of a compulsion, they kind of have to keep going back to the device, uh, craving, so they're thinking about it.
• 3:19
  Speaker: What am I getting for Christmas?
• 3:21
  Speaker: What are, you know, what am I getting for my birthday?
• 3:24
  Speaker: And it's constant, nonstop sort of badgering, coming home from school, and the first thing they think about is screen time.
• 3:30
  Speaker: So any of those kind of behaviors I would call red flags.
• 3:34
  Speaker: Um, and then a negative relationship too.
• 3:36
  Speaker: So if we're seeing decline in grades, change in relationships, spending more time, so tolerance and more and more time on the device, and then withdrawal.
• 3:44
  Speaker: So anytime they come off the device, now they're irritable, um, you know, cranky, throwing a tantrum, all of those I would say are red flags to consider.
• 3:54
  Speaker 1: So what worries me here is that, you know, we're you and I are talking on an electronic device now.
• 4:00
  Speaker 1: Um my son has a tablet, my daughter will get a cell phone because I'd like to know her location sometimes, or you name it, the kids learn on electronics at school.
• 4:11
  Speaker 1: I I think there's no getting away from this.
• 4:13
  Speaker 1: Is this a growing problem or is it already a full-throated problem?
• 4:16
  Speaker 1: I mean, electronics are not going anywhere.
• 4:20
  Speaker: Absolutely.
• 4:20
  Speaker: And I think it goes both ways, right?
• 4:23
  Speaker: So um parents modeling some of this behavior too, right?
• 4:26
  Speaker: So if a parent is tracking their child, giving them a smartphone, quote unquote, for safety reasons, right, to know where they are at all times.
• 4:34
  Speaker: Um, some of that reflects some parental anxiety too, right?
• 4:37
  Speaker: Knowing where they are doing.
• 4:39
  Speaker: But that is a slippery slope because now that smartphone, that device, uh opens them up to the whole world.
• 4:45
  Speaker: Um, and the other thing that we see is um 95%, there's there's studies that show 95% of children are on their phones constantly, teenagers are on their phones constantly, online constantly.
• 4:56
  Speaker: And so we're seeing disruption in things like sleep, um, their eating patterns, relationships.
• 5:02
  Speaker: Um, and and and with someone with a pre-existing mental illness or someone who is at risk of having things like depression, anxiety, uh, we're seeing those exacerbated.
• 5:14
  Speaker 1: You see, that and that's a good point.
• 5:15
  Speaker 1: I could totally see where screens can take in a preexisting condition or you know, ADHD or anxiety or depression, and then put that same person in front of a screen for a while and it just makes it worse.
• 5:27
  Speaker 1: Is that something you've been seeing a lot of?
• 5:30
  Speaker: We absolutely do.
• 5:31
  Speaker: Um, a lot of times we are seeing um individuals come in looking for a diagnosis of ADHD, um, sometimes bipolar diagnosis.
• 5:40
  Speaker: Um, and what we're seeing is um uh the inattention when you ask more questions and dig deeper, um, the inattention is coming from lack of sleep, for example.
• 5:52
  Speaker: So someone who hasn't slept well at night, um, a lot of times when we ask questions, they've been getting three, four, or five hours of sleep, which is not nearly enough for a teenager.
• 6:03
  Speaker: A teenager should be getting about nine to ten hours of sleep.
• 6:06
  Speaker: Um, so when a clinician hears that someone is inattentive, I would strongly recommend sort of digging a lot deeper because there might be other things contributing.
• 6:19
  Speaker: Um, they might not be sleeping because they're talking to friends.
• 6:21
  Speaker: The story I hear most often is they've made friends in other countries who live in other time zones.
• 6:27
  Speaker: So they're awake at all hours of the night talking to, you know, um this person.
• 6:31
  Speaker: And now at school they're sleeping or inattentive.
• 6:35
  Speaker: Um, and so it might look like ADHD, but it's actually um, you know, a screen problem.
• 6:40
  Speaker: And taking away that screen problem usually fixes the inattention.
• 6:45
  Speaker 1: Oh, that's interesting.
• 6:46
  Speaker 1: So it's not all cases where PMU should be the secondary diagnosis.
• 6:51
  Speaker: Not in all cases.
• 6:52
  Speaker: Yeah, I think you know, sometimes it masks it masks those those symptoms and um it's kind of mimics those symptoms, but a lot of times it is the screen that that is the problem.
• 7:02
  Speaker 1: Oh, geez, it's almost like we humans aren't really made for this type of input, having a lighted rectangle shining in our face instead of being quiet in the woods somewhere.
• 7:13
  Speaker: Yeah, I would say, you know, we are social creatures, but you know, everything uh within moderation, right?
• 7:19
  Speaker: So if you are going to be social creatures, but social creatures 24-7, uh, then that is going to cause a problem.
• 7:26
  Speaker: So I think um kind of going back to your point, um, you know, there needs to be the it is hard sometimes to self-regulate, but there needs to be some kind of process in place where whether parents or children are able to just you know disconnect from those devices, um, the family's talking about it as a whole.
• 7:48
  Speaker: Um, and parents are modeling some of this behavior, right?
• 7:50
  Speaker: So no screens, I would say no screens in the bedrooms if possible, um, no screens um at the dinner table if possible, you know, just having some general rules that that that can help sort of take away those devices from from key points in in their life, in their day-to-day life.
• 8:09
  Speaker 1: What are some other issues that come along with Pimu?
• 8:12
  Speaker 1: I can say that you know, anxiety has often led to higher blood pressure and other poor physical health outcomes.
• 8:19
  Speaker 1: But with Pimu, uh, what what does that lead to physically speaking?
• 8:24
  Speaker: I think obesity rates are much higher in you know, in in children who are under that umbrella term of Pimu, we are seeing higher obesity rates.
• 8:34
  Speaker: Now, that can come from many things.
• 8:35
  Speaker: It could come from being sedentary for hours at a time, not having that balance, right?
• 8:41
  Speaker: So not balancing that screen use with outdoor activities.
• 8:45
  Speaker: Um, that can also come from mindless eating.
• 8:47
  Speaker: So someone is on their device scrolling for hours and eating at the same time, then they're the cues of unicatiety, the cues of I am full, none of that is happening.
• 8:57
  Speaker: And so I think it's very important to um to be able to untangle some of those things.
• 9:05
  Speaker: Um, so we are seeing higher obesity risks.
• 9:07
  Speaker: Um, we're also seeing um I've recently been to a conference where they talked about vision and how um you know children's vision is impacted and how um individuals are coming in with uh more um you know vision problems because they're on devices uh nonstop.
• 9:22
  Speaker: And things I hear from children is I turn on the blue light filter, the blue light canceling filter and all these stories, right?
• 9:29
  Speaker: But none of that seems to work.
• 9:30
  Speaker: And so I do think it's important to kind of remind children about their eyes, um, their you know, um obesity risks when you when you talk to them.
• 9:39
  Speaker: Um and physical activity is super important for mental health, right?
• 9:42
  Speaker: Just a couple of minutes a day of just getting outside can do uh wonders.
• 9:47
  Speaker: Um, and the other thing about social interactions, we talked about how we're social creatures and it's important to have those social connections.
• 9:54
  Speaker: Now there are studies that show um the interactions on a device is very different from face-to-face interactions.
• 10:03
  Speaker: And so there's a lot that's lost if someone's texting.
• 10:06
  Speaker: Um, there are cues like emotional cues, those kind of things that are lost um through a device versus face-to-face interaction.
• 10:14
  Speaker: Um so just kind of remembering those effects as well.
• 10:18
  Speaker 1: And we all heard of uh TextNEC and people getting dowager homes pretty early on in their lives.
• 10:23
  Speaker: Yeah, I mean, people do talk about, you know, having twitches and spasms and those kind of things.
• 10:28
  Speaker: Um, and then it's very interesting uh that you bring this health uh piece up, you know, um there's a lot of influencers out there that um have no medical background, uh, but just because they have several followers, uh, you know, the credibility, their credibility comes from the number of followers they have, uh, but they have no medical background per se.
• 10:49
  Speaker: And they are peddling things such as bed rotting for mental health, which is staying in bed for hours at a time as a way of relaxing, but that is a slippery slope, and we are seeing people, you know, go deeper into depression if you're gonna stay in your bed all day.
• 11:04
  Speaker: Uh, that is not good for anybody.
• 11:06
  Speaker: Um, so I I would say, yeah, it is what we're seeing right now is a wildfire.
• 11:13
  Speaker: And um, yeah, these platforms are sticky by design.
• 11:17
  Speaker: Platforms, games, what you have are all sticky by design.
• 11:21
  Speaker 1: What makes them so sticky?
• 11:23
  Speaker: Yeah, so I think short content form is what makes them very sticky.
• 11:27
  Speaker: Um, so this kind of falls back on my substance use uh, you know, background and and um research interests.
• 11:35
  Speaker: Um the shorter the half-life of a drug, the more addictive it is.
• 11:40
  Speaker: Um and so very similar to short, short form content.
• 11:43
  Speaker: So the shorter the content is, that next hit, that next dopamine surge is much greater.
• 11:50
  Speaker: And so um the shorter form videos uh make them very sticky by design.
• 11:55
  Speaker: People are on there scrolling because you've watched one video and you're just curious what the next one is.
• 12:00
  Speaker: There is an autoplay feature, so the next one sort of comes up on its own.
• 12:04
  Speaker: And so I think that that is another thing that makes it very sticky by design.
• 12:07
  Speaker: Um and then just the algorithms that the platforms use um are also sticky by design.
• 12:15
  Speaker: It's very colorful.
• 12:17
  Speaker: Um, it is showing you the content you want to see.
• 12:21
  Speaker: So um sometimes it's it's funny I say, you know, we talk about something and all of a sudden it's popping up in our phone as a suggestion.
• 12:28
  Speaker: Hey, would you like to buy this vacuum?
• 12:30
  Speaker: And you know, it's it's very interesting how our phones are listening to us.
• 12:34
  Speaker: So I would say just the algorithms that go into these platforms.
• 12:39
  Speaker: And for children, it's it's particular because if you see sometimes a child's uh feed or page, you see like cocoa melon ads, um, things that are targeted towards children, you know, and so um yeah, a lot of it is is sticky by design.
• 12:54
  Speaker: And so there is this addictive uh piece um that that comes from the way these websites, these platforms are designed in the first place.
• 13:03
  Speaker 1: And once we have that stickiness, it can act almost like a drug, just like uh, you know, heroin addiction or opiate addiction.
• 13:10
  Speaker 1: Okay, the opiate's not there, but the same dopamine reward pathway is still there that reinforces the use of screens to begin with.
• 13:17
  Speaker: Correct.
• 13:18
  Speaker: Yeah, it is the same pathway that's being hijacked.
• 13:20
  Speaker: Um, it's that dopamine surge.
• 13:22
  Speaker: Um, and then going back for more.
• 13:24
  Speaker: Um, and then it's just endless, right?
• 13:26
  Speaker: There's like an endless supply of it.
• 13:28
  Speaker: And I think that's what makes it really scary.
• 13:31
  Speaker 1: Absolutely, and scary is the word.
• 13:34
  Speaker 1: So I think that is enough for this part.
• 13:37
  Speaker 1: Uh, but when we come back, I'd like to talk more about you know screening and treatment.
• 13:42
  Speaker: That sounds great.
• 13:45
  Speaker 1: You've been listening to Mind and Medicine, a Sentera podcast.
• 13:48
  Speaker 1: As a reminder, please check the show notes for details on how to claim your continuing education credits, as well as any resources mentioned in the episode.
• 13:55
  Speaker 1: That's it for now, but keep an eye out for another episode and more evidence based education for healthcare providers on the go.
• 14:01
  Speaker 1: You well.