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In this section, current research is presented on youth smartphone and social media use, two experiences that are highly connected given that smartphones are a primary way of accessing social media and social networking sites (Kuss & Griffiths, 2017). Although this is still an area of emerging research, this page will present some promising practices that you can incorporate into your work supporting young people. As new research becomes available, the information on this page will be updated.
Adolescence is the phase of life between childhood and adulthood, typically ages 10 to 19 (World Health Organization, n.d.). However, research into smartphones and social media can also include young people up to 24 years of age. Today’s youth, a generation of young people who are sometimes referred to as “Gen Z,” “Digital Natives” or “iGen,” have grown up using the Internet and other digital technologies from a very young age (Twenge, 2017). The way young people engage with technology today is an area that attracts discussion and debate. The term “addiction” is often used in the news media when referring to excessive technology use (Yu & Sussman, 2020). There has also been increased concern about this topic in recent years given the increased time spent online and using digital technologies during the COVID-19 pandemic (Masaeli & Farhadi, 2021).
It is important to note that there is no formal clinical diagnosis for smartphone, social media or Internet addiction in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013) or the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2020). To date, only Internet gaming disorder has received formal recognition in the ICD-11 and has been included in the DSM-5 as a condition requiring further research (Parekh, 2018; World Health Organization, 2020).
At the Centre for Addiction and Mental Health (CAMH), we recommend using person-first language that reduces stigma and does not pathologize young people’s experiences. For example, “youth who engage with/have a relationship with technology” acknowledges both the beneficial and detrimental aspects of technology use. When a young individual is experiencing significant harms related to their technology use, we suggest using terms such as “youth experiencing” problem technology use (PTU), problem smartphone use (PSU) or problem social media use (PSMU). Using these terms rather than “addiction” can help to reduce stigma.
It also acknowledges how people’s relationship to technology can change across time and different contexts, and that there is no fixed, universal diagnostic criteria or threshold for harmful smartphone or social media use (Throuvala et al., 2019; Yu & Sussman, 2020). This is supported by the research that suggests moving away from an addiction framework and considers sociocultural contexts of technology use, balancing problematic use with functional, enjoyable use and an individual’s motivations for using technology (Panova & Carbonnell, 2018).
What does the evidence say?
The 2019 CAMH Ontario Student Drug Use and Health Survey is a longitudinal survey of the mental health and well-being of youth in Ontario. Although there are encouraging findings that show that the majority of Ontario students do not experience problem technology use, below are some key findings regarding youth technology use in Ontario (Boak et al., 2020):
- Over a third (35%) of Ontario’s secondary school students spend five hours or more daily on electronic devices (smartphones, tablets, laptops, computers, gaming consoles) in their free time.
- One in two students or more report excessive screen time and sedentary behaviours.
- Female students are significantly more likely than male students to spend over five hours a day on social media.
- Students in grades 9 to 12 are more likely to spend over five hours a day on social media.
- One in five students report symptoms of moderate to serious problem technology use (preoccupation, loss of control, withdrawal, problems with family/friends).
- One in five students report being cyberbullied.
- One in five students report using social media for at least five hours per day in their free time, an increase from 11% in 2013.
- Around three per cent of secondary school students (representing 21,200 students across Ontario) report symptoms that may suggest a serious problem with technology use.
- One in five students report posting something personal on social media that they wish they had not.
- For students in grades 10 to 12, over one quarter (28.9%) report texting while driving at least once in the past year (this represents an estimated 73,000 adolescent drivers in Ontario).
- One in two students or more report they are not getting at least eight hours of sleep on average on a school night.
The findings from this large, provincial survey were similar to those found across large-scale studies in the United States and internationally (Sohn et al., 2019; Twenge, 2017).
Negative impacts of PTU
In the last decade, across Ontario and North America, social media use has significantly increased in parallel with the number of children and adolescents reporting moderate to severe mental distress, including suicidal ideation or attempts (Abi-Jaoude et al., 2020; Boak et al., 2020). Today’s youth also report lower life satisfaction and higher rates of loneliness compared to previous generations (Fischer-Grote et al., 2021; Twenge, 2017). Although it is difficult for researchers to definitively say this rise in mental distress is related to the arrival of smartphone technology and social media, empirical, cross-sectional, longitudinal research links the increased prevalence in technology with depression, anxiety, chronic stress and low self-esteem (Abi-Jaoude et al., 2020; Elhai et al., 2017; Twenge, 2017).
Multiple systematic reviews of studies conducted across many countries (including the UK, China, Germany, Japan, Finland, Israel and the USA) have found that, for young people, excessive smartphone use was associated with an increased risk of depression and anxiety, high levels of perceived stress levels, and poor sleep quality and shorter sleep duration (Sohn et al., 2019; Thomée, 2018). Sleep quality, in particular, is thought to be negatively affected by technology use and can result in later bedtimes, sleep onset latency, shorter sleep duration, insomnia or sleep problems, reduced sleep quality and reduced daytime functioning due to tiredness (Thomée, 2018). Phone use around bedtime was also found to be associated with depressive symptoms, anxiety and stress, low self-esteem and, in some instances, reduced cognitive performance (Thomée, 2018).
Social media has also been shown to affect young people’s self-image and interpersonal relationships, promote social comparison, and facilitate cyberbullying and self-harming behaviours (Abi-Jaoude et al., 2020). Increased media multitasking (i.e., moving between multiple social media applications) can also negatively affect sleep, cognitive control, academic performance and socioemotional functioning (Abi-Jaoude et al., 2020). Young people today also have to navigate interacting with a range of potentially harmful content such as misinformation, conspiracy theories and deliberately polarizing content (Jiang et al., 2021).
A number of studies have highlighted that young females are more at risk of experiencing PSU, PSMU and cyberbullying than males (Boak et al., 2020; Twenge 2017; Yu & Sussman, 2020). They are also more likely to report mental distress, self-injuring behaviour and suicidality related to their smartphone or social media use (Abi-Jaoude et al., 2020).
Suicide. It is important to note that there is significant research linking problem technology use to increased risk of non-suicidal self-harming behaviours, suicidal ideation and exposure to harmful content or “challenges” online (Deslands & Coutinho, 2020; Thomée, 2018; Steinbüchel et al., 2018). These online challenges take place on social media platforms where young people are encouraged to take part in risky and/or self-harming behaviour and document it on the platform, sometimes triggering competition between individuals. An example of this would be ingesting harmful substances, such as the “Tide Pod Challenge” or drinking alcohol gel (Canadian Broadcasting Corporation, 2018; Deslands & Coutinho, 2020).
Data for young people in North America indicates that risk for suicide increases with screen time of two or more hours per day (five or more hours per day was linked to considerably higher risk for suicide; Twenge, 2017). One of the contributing factors to this risk might be that two thirds of young people who experience cyberbullying have at least one suicide risk factor (Twenge, 2017). However, being online can also provide young people facing these issues with access to online support communities, crisis support and reduced feelings of isolation (Marchant et al., 2017; Thomée, 2018).
Some of the most apparent positive impacts of social media and smartphones are increased social connectedness, identity formation, access to information and entertainment (Kuss & Griffiths, 2017; Ryding & Kuss, 2020). For some young people, being online also meets a basic need for safety and connection when gathering in person may not feel safe or may not be feasible due to safety concerns from parents or caregivers (Kuss & Griffiths, 2017). Young people also use social media and online communities in creative ways to produce digital media on platforms such as YouTube, Instagram and TikTok. These online communities and opportunities to create meaningful digital content allow young people to acquire and co-create knowledge and contribute to social causes they feel passionately about, like stigma reduction (Zahn et al., 2014).
Regarding social media specifically, one systematic review found that social networking platforms can provide opportunities to find social support, form an identity, build self-esteem, and support communication and learning for youth at risk of or experiencing depression or other mental health concerns (Best et al., 2014; Rice et al., 2014). Social networking in these instances can increase self-esteem, create a sense of belonging and social support, and lower barriers to self-disclosure, therefore acting as a desirable alternative to traditional help-seeking behaviours (Best et al., 2014).
Social media sites can also offer micro-boosts to young people’s self-esteem when they experience receiving a friend request or being “liked” or “followed” by peers (Cole et al., 2017). Finding sources of social support online can also be particularly meaningful for young people who have weaker in-person social networks (Cole et al., 2017). Online friends can be an important source of social support, particularly for 2SLGBTQ+ youth (Ybarra et al., 2015). However, it is important to note that rates of online peer victimization and sexual victimization are also particularly high among 2SLGBTQ+ youth, which means this group of young people may need spaces in which they feel safe and supported online.
There is also promising research that shows the use of technology, such as video games, in supporting psychotherapy and psychoeducation for young people (Ceranoglu, 2010; Jung & Gillet, 2011). Recently, there has been a large number of evidence-based mental health applications that are accessible to young people via their smartphones. Please see the Resources section below for more information.
So, what might predispose a young person to use technology in a harmful or problematic way? Some researchers have suggested that distracted, habitual and problem smartphone use are associated with the following factors:
- Online vigilance: Internal thoughts or external cues that lead to a preoccupation with online content, and then lead to increased monitoring and frequent phone checking behaviours (i.e., “online vigilance”).
- Attention impulsiveness: Difficulties with inhibitory control or executive control functions (i.e., chronic multitasking can lead to frequent, rewarding checking behaviours).
- Fear of missing out (FOMO): A fear of being excluded from rewarding social experiences.
- Fear of no access to a smartphone/mobile device: A fear that triggers a need to be in constant contact and rewards use. Smartphone unavailability and intolerance of uncertainty are associated with problem smartphone use and affect perceived stress and mental well-being.
- Stress, anxiety, emotion regulation and problematic use: Relief of negative emotions and psychological states along with emotional gains from smartphone use have been found to be significantly higher for Gen Z (individuals born between 1995 and 2015).
- Trauma and/or adverse childhood experiences (ACE): Emerging evidence has linked the presence of household dysfunction to increased risk of problem smartphone use (Foster et al., 2021).
- Sex differences: Females are more likely to experience problem smartphone/social media use and twice as likely to report experiences of cyberbullying than males (Boak et al., 2020; Twenge 2017; Yu & Sussman, 2020).
- Different personality or lifestyle factors: Insecure attachment style, loneliness, shyness, social anxiety, high levels of neuroticism, academic pressures, low self-esteem, low agreeableness, low openness, low conscientiousness, low self-efficacy and dissatisfaction with their external environment.
- Smartphone use habits: Younger age at first smartphone use, excessive use during a weekday.
- Co-occurring psychiatric disorder symptoms: Including depression, anxiety, ADHD, OCD or personality disorders (Boak et al., 2020; Boumosleh & Jaalouk, 2017; Hussain & Griffiths, 2018; Kuss & Griffiths, 2017; Liu et al., 2019; Sohn et al., 2019; Steinbüchel et al., 2018; Thomée, 2018; Throuvala et al., 2020; Twenge, 2017; Zhitomirsky & Blau, 2016).
How do I put this evidence into practice?
One of the challenges for professionals working with young people can be trying to determine when technology use becomes problematic or harmful, rather than something that is enjoyable or serves a function in the young person’s life. There is the added difficulty of trying to separate what behaviours a technological device such as a smartphone or digital device may be facilitating (e.g., playing video games, texting, e-mail, social media applications, media streaming, online shopping or pornography use; Ryding & Kuss, 2020; Yu & Sussman, 2020).
Screening for problem smartphone use
A lack of standardized criteria with which to measure problem smartphone use makes screening and assessment challenging for clinicians.
There are at least 78 validated scales of problem smartphone use, but many are based on DSM-IV or DSM-5 criteria for gambling disorder or substance use disorder, despite ongoing debate as to whether problem smartphone use should be considered an “addiction” as opposed to a “maladaptive behaviour” (Harris, Regan et al., 2020). Some screening tools use Griffiths’ (2005) six-component model of addiction (conflict withdrawal, tolerance, salience, mood and relapse) while others are an adaptation of Young’s (1999) Internet addiction test.
Comparing these scales to determine which is the most valid and reliable is challenging because some scales lack measures for internal consistency and test-retest reliability (Harris, Regan et al., 2020). However, one scale that has been found by several systematic reviews to be the most popular and appropriate for use with adolescents (Harris, McCredie & Fields, 2020; Thomée, 2018; Yu & Sussman, 2020) is the 10-item Smartphone Addiction Scale–Short Version for Adolescents (SAS-SV).
Originally developed to detect problem smartphone use with South Korean adolescents (Kwon et al., 2013), the SAS-SV’s reliability and validity have also been confirmed by research with 18- to 24-year-olds in the United States as an accurate indicator of problem smartphone use (Harris, McCredie & Fields, 2020).
The scale is currently open access and asks individuals for a rating of strongly disagree (1), disagree (2), weakly disagree (3), agree (4) and strongly agree (5) for the following 10 statements:
- Missing planned work due to smartphone use
- Having a hard time concentrating in class, while doing assignments, or while working due to smartphone use
- Feeling pain in the wrists or at the back of the neck while using a smartphone
- Won’t be able to stand not having a smartphone
- Feeling impatient and fretful when I am not holding my smartphone
- Having my smartphone in my mind even when I am not using it
- I will never give up using my smartphone even when my daily life is already greatly affected by it
- Constantly checking my smartphone so as not to miss conversations between other people on Twitter or Facebook
- Using my smartphone longer than I had intended
- The people around me tell me that I use my smartphone too much
SAS-SV scores of 31 for males and 33 for females have been proposed as a potential clinical cut-off point indicating problem smartphone use, although this has been interpreted by researchers with caution (Harris, Regan et al., 2020). We therefore recommend using the statements in this scale as a starting point to discuss harmful smartphone use with clients as part of your overall assessment to discover more about their experiences of technology.
Screening for problem social media use
The Bergen Social Media Addiction Scale (BSMAS) is regarded as an accurate and valid measure of problem social media use among adolescents (Bányai et al., 2017; Cheng et al., 2021). The scale is based on addictions theory and uses Griffiths’ (2005) aforementioned six-component model of addiction (Andreassen et al., 2017).
All items are scored on the following scale: very rarely (1), rarely (2), sometimes (3), often (4) and very often (5). During the last year how often have you:
- spent a lot of time thinking about social media or planned use of social media?
- felt an urge to use social media more and more?
- used social media in order to forget about personal problems?
- tried to cut down on the use of social media without success?
- become restless or troubled if you have been prohibited from using social media?
- used social media so much that it has had a negative impact on your job/studies?
BSMAS scores over 19 and 24 have both been proposed as a potential clinical cut-off point indicating problem social media use (Bányai et al., 2017; Luo et al., 2021). However, as with the SAS-SV, we recommend using the items in this screening tool as a starting point to discuss social media use with clients to determine if they are experiencing problem social media use.
Alternative measures of PSU/PSMU
Asking questions about the following categories has also been suggested by researchers an alternative source of discovering information about a young person’s technology use:
- total screen time
- time spent on particular apps
- frequency of checking
- time spent per interaction
- notification checking.
If a young person is gaming via their smartphone, it may be worth asking about their hours spent playing, player ranking/leaderboard scores or trophies they have earned (Harris, Regan et al., 2020; Ryding & Kuss, 2020).
The above measures can also be more valuable than measuring total screen time alone, which may not indicate what areas of a young person’s technology use (if any) may be harmful or problematic (Ryding & Kuss, 2020). Exploring these behaviours with the young person using a data monitoring app or their phone’s built-in settings can complement self-reporting data, which can often underestimate unconscious or compulsive behaviours. This option may be worth exploring with clients if they feel comfortable sharing this information (Ryding & Kuss, 2020). We recommend that you keep informed of current data tools available via applications and through the most popular smartphone operating systems (i.e., Android’s Digital Wellbeing settings and iOS Screen Time monitoring features).
Other areas worth exploring as part of your assessment with a young person can be some common risk factors and negative impacts of problem smartphone and social media use, such as:
- anxiety and withdrawal symptoms when not using the smartphone/social media
- negative impacts in personal, social and occupational areas of a young person’s life
- distorted perceptions of time
- cyberbullying, harassment or privacy concerns
- anxiety related to FOMO
- any financial costs incurred from social media, gaming, or applications purchased (Kim et al., 2015; Rice et al., 2014; Turel & Cavagnaro; 2019; Twenge, 2017).
Given the links between problem social media/smartphone use and increased risk of suicide, it is highly recommended that you carry out ongoing risk assessment for suicide and self-harming behaviours when working with young people. One suggestion from the research is to ask young people experiencing or at risk of self-harm, suicidal ideation or behaviours about their Internet and social media use during the assessment process. This could include asking about the role of images/videos and designing treatment plans that seek to maximize beneficial online behaviours and reduce harmful behaviours (Marchant et al., 2017).
For additional resources and information about suicide and crisis interventions approaches, visit our Suicide Evidence-Informed Practice page.
Research on effective interventions for young people experiencing PSU/PSMU is still needed. Whatever approaches you use in your work, it is important to consider the following general therapeutic guidelines when working with young people:
- Developing a strong therapeutic alliance based on open communication, non-judgment, trust and emotional safety has been shown to be crucial when working with young people. For older youth, in particular, promoting a sense of inclusion and autonomy will also support any type of behaviour-change work.
- Using thoughtful assessment questions or motivational interviewing to explore all aspects of a young person’s digital life (both positive and negative).
- Taking a harm reduction approach. Note that this may not necessarily focus on overall screen time but using the data from specific apps or information provided by the young person to look at specific risks or behaviours where harm can be reduced.
- Reducing or supporting the young person with their co-occurring symptoms (e.g., anxiety and depression).
- Fostering peer support through group work or helping a young person foster social skills and confidence they can use outside of their individual session.
- Taking an approach informed by narrative therapy, where working with a young person also includes exploring their strengths and values, includes their own assessment and appraisal of their tech use, and objectifies the problem rather than the young person. This approach also takes a position of the young person as expert or consultant to their own experiences (Abi-Jaoude et al., 2020; Andersen-Giberson, 2016; Bozzola et al., 2019; Kim & White, 2018; Throuvala et al., 2019; Twenge, 2017).
For specific intervention approaches, current research has predominantly focused on three interrelated areas:
Behavioural interventions focusing on behaviour change are an effective way to begin to reduce harmful PSU/PSMU and can be used in combination with cognitive behavioural therapy (CBT) and educational interventions (see below). Working with youth in a group counselling/support format also allows young people to participate socially, improve their interpersonal communication and share space with others going through similar experiences and emotions (Liu et al., 2017). Group counselling has also been linked to a reduction in feelings of depression, anxiety and aggression when paired with CBT and sports interventions (Liu et al., 2017). Sports interventions in particular can be a low-cost way for young people to reduce harmful smartphone or social media use and has been linked with an improvement in executive function, impulse control and redirecting attention (Liu et al., 2019).
Individual and group CBT sessions have been found to reduce self-reported levels of depression, aggression, stress, and anxiety, and can lead to improved peer relations (Khalily et al., 2021; Liu et al., 2017). Components of CBT interventions can include:
- identifying triggers for excessive use
- identifying protective factors to stop excessive use
- increasing awareness of problem smartphone use and encouraging the young person to investigate what this might look like for them
- identifying alternative replacement activities
- using relaxation techniques such as deep breathing and progressive muscle relaxation
- practicing activities such as prayer and reading religious scripts (for young people who are part of a particular community) to cope with feelings of distress
- setting a period of time (e.g., 48 hours) where the young person is encouraged not to use any electronic devices
- providing education around a “digital diet” or positive habits, such as not using smartphones for the first hour of the day after waking or creating “no smartphone zones”
- providing education around the negative effects of excessive smartphone use (such as impact on sleep)
- providing cognitive restructuring for cognitive distortions, overgeneralization and negative core beliefs previously associated with Internet addiction (Malinauskas & Malinauskiene, 2019; Young, 2009).
Providing education to young people about the risks and impacts of PSU/PSMU was an intervention component found throughout the research literature, whether it formed part of an individual or group intervention, or was part of a wider-level education/prevention program (i.e., school-based prevention; Khalily et al., 2021; Liu et al., 2019; Malinauskas & Malinauskiene, 2019). Education interventions can involve:
- Spending time talking to the young person about mental distress and suicide, and providing psychoeducation around known risks of social media and smartphone use to mental health and well-being.
- Building habits that promote good quality sleep (e.g., avoiding screens one to two hours before bed, not having devices in the bedroom at night, maintaining a regular sleep schedule; Irish et al., 2015).
- Involving family and caregivers, if appropriate. Multi-level counselling and education around PSU/PSMU have been shown to be effective as well as working with families to set parental limits for younger children. Older adolescents may benefit from an open discussion focusing on positive engagement and adults modelling healthy smartphone and social media use (including creating set times or areas for smartphone/social media use at home).
- Building key skills and competencies that can enhance protective factors against PSU/PSMU, such as critical thinking and evaluation skills, problem-solving skills, social skills, self-reflection, media literacy, etc.
- Teaching positive psychology approaches (designed to increase positive emotions and enhance social competencies) as well as components of mindfulness (active observation, awareness, self-monitoring and mood tracking apps) have been shown to be low-cost, effective methods to increase protective factors against PTU (Throuvala et al., 2019).
The main limitation to consider is that there is a large amount of growing evidence into problem smartphone use, problem social media use and problem technology use more broadly. As noted previously, there is a lack of agreement in the research how PSU/PSMU should be conceptualized, defined, or measured, and whether these behaviours could constitute a behavioural addiction (similar to gambling disorder or Internet gaming disorder) or whether they should be conceptualized differently (Harris, Regan et al., 2020).
Of the literature reviewed, many of the studies focusing on youth took place in South, Southeast or East Asian countries. This may limit the generalizability of some of the findings of these studies unless they are replicated with youth in North America (Malinauskas & Malinauskiene, 2019; Yu & Sussman, 2020).
Although the evidence reviewed on this page includes many large-scale trials, meta-analyses and systematic reviews, it has been noted by some researchers that only a small number of these studies used a longitudinal design or follow-up (Thomée, 2018). An overreliance on self-report data and convenience sampling in these studies could also be considered a limitation (Ryding & Kuss, 2020; Thomée, 2018). However, there are promising attempts to collect more objective data via randomized controlled trials (RCTs) with bigger sample sizes happening in this area of research (Yu & Sussman, 2020).
- 2019 Mental Health and Well-Being of Ontario Students: Detailed Findings from the Ontario Student Drug Use and Health Survey
- The App Evaluation Model: An evaluation model for mental health and addictions service providers and their clients to evaluate the suitability and effectiveness of mental health applications.
- Common Sense Media: A non-profit organization providing education and information about digital media including Digital Citizenship and age-appropriateness ratings for movies, TV, applications and games. It includes a helpful “Parents Need to Know” guide on cellphones, screen time and online privacy and safety.
- Cybertip.ca: Additional resources about online exploitation and victimization of young people and ways to report online abuse and exploitation of children and young people.
- Problem Technology Use Evidence-Informed Practice page: GGTU’s evidence-informed practice page on problem technology use.
- GGTU's Suicide Evidence-Informed Practice page: GGTU’s evidence-informed practice page on suicide.
- NeedHelpNow.ca: Resources aimed directly at youth who may be at risk of or experiencing cyberbullying, or who have had personal or graphic images shared online or on social media.
- One Mind PsyberGuide: This non-profit website reviews mental health apps for their credibility, user experience and transparency.
- ProtectKidsOnline.ca: Resources aimed at families, caregivers and professionals for protecting young people online, including information about online exploitation, cyberbullying, healthy online relationships and boundary setting.
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