Literature Review
Increase use of Technology and Mental Health Symptoms
Smartphones provide adolescents with continuous social connectivity that, despite its utility, poses certain difficulties. Self-expression in the form of sharing photos, thoughts, feelings, life events, and current whereabouts and activities has long been considered a major motivation for social media engagement, and many teens feel pressure to share self-enhancing or attention-grabbing content in order to increase their social appeal (Hawk, Eijnden, Lissa, & Bogt, 2019). Smartphones likely intensify such behavior by creating opportunities to share any spur-ofthe-moment musing or experience with one’s entire social network. Additionally, posting “selfies” is a prevalent form of social media behavior that is almost exclusively smartphone based. Smartphones are likely to increase adolescents’ frequent use of social media for purposes of self-expression, interpersonal connection, and social validation (Hawk et al., 2019).
An increase in technology is obvious and can be seen everywhere, in schools, restaurants, airplanes, cars, and homes. Using the internet has become a part of everyday life for most individuals, especially adolescents ages 13-17 (Law et al., 2012). The increase of technology brings amazing things, especially in this time of COVID-19 and social-distancing, while also bringing feelings of isolation, disconnect, loneliness and Fear of Missing Out (FoMO), a construct which can be defined as a pervasive worry that others might be having rewarding experiences from which one is absent; it is characterized by the desire to stay continually connected with what others are doing (Fabris, Marengo, Longobardi, & Settanni, 2020). With the growth of discussion about mental health comes more individuals hiding behind a screen, saying hurtful and disparaging statements without consequences.
Along with growing mental health awareness, most of the population owns a smartphone, which means immediate and 24-hour access to the internet, social media, news, and streaming services. In the United States, the proportion of adults who use social media increased from 7% in 2005 to 65% in 2015, representing an increase of almost 1000% (Vally & D’Souza, 2019). Adolescents are spending nine hours on some type of screen, with three of those hours being on their mobile phone, texting, scrolling through social media, taking pictures and videos, and so much more (George, Russell, Piotnak, & Odger, 2018). Research shows that 93% of North American adolescent’s report going on the internet and 89% have access to the internet, from their own smartphone, computer, tablet, or parent’s smartphone (Law et al., 2012).
Social Media
Social media can be a useful tool for connecting with family or friends that live across the country or to learn a new recipe; it becomes not as useful when adolescents are fixated on whatever is on their screen, using their social media as a distraction from feelings certain emotions or avoiding homework. Being online for three or more hours per day has shown decreases in social skills, attention, focus, and mental health (George et al., 2018). George and the team also report that adolescents spend less social time in person with peers but substitutes that time by interacting with peers online. The modern digital world offers nonstop technology making it almost impossible to unplug and it is increasingly evident that many psychological problems can be caused or exacerbated by such technology (Scott, Valley, & Simecka, 2016).
This constant connectivity might also result in greater levels of stress and dependency related to these technologies. Adolescents who regularly use their smartphones for communication or social media sharing might experience distress and anxiety when they find themselves without access to their devices, and unable to post new content or immediately respond to friends’ text messages and social media feedback (a condition sometimes called “nomophobia”) (Hawk et al., 2019). They can also become overwhelmed by the amount of social media information they might need to process to maintain connection and avoid missing out on important events (Hawk et al., 2019).
Along with connection, both self-disclosing and receiving positive feedback on social media posts are fundamentally rewarding experiences. Smartphones provide the opportunity for individuals to share new content and monitor its popularity constantly, which might create a behavior-reward feedback loop that serves as a basis for addiction (Hawk et al., 2019). The clinical cataloging of social media and smartphone addiction are still debated and not currently classified as disorders in the DSM-V as it is stated that further studies are needed. However, numerous studies in recent years have linked compulsive or “addiction-like” social media and smartphone behaviors to numerous behavioral, emotional, social, and academic struggles among adolescents in North America, Europe, and Asia (Hawk et al., 2019).
The term “problematic use” is used in the present research in order to draw parallels with other current studies that might more freely use the term “addiction”, without directly addressing the debate regarding clinical cataloging (Hawk et al., 2019). Regardless of formal clinical recognition, the problematic use of social media and smartphones and adolescents’ growing dependence on these technologies for needs gratification, are interrelated issues that warrant further attention (Hawk et al., 2019). Considering recent studies linking youth’s psychosocial problems to increased time spent with social media, there is a critical need for integrative models of the personality, interpersonal, and motivational factors that predict both normative and problematic forms of social media and smartphone use (Hawk et al., 2019). Along with Hawk and team, Vally and D’Souza (2019) also found the emergence of “problematic social networking sites (SNS) use”, which refers to symptoms resulting from excessive and maladaptive SNS use and that are characterized by addictive tendencies.
Technology is redefining normal versus abnormal behavior by changing the term connectivity, 24-hour accessibility, and overall information overload (Scott et al., 2016). By increasing the flood of incoming demands on time and energy, the darker side of technology (in the form of connectivity, accessibility, and information overload) can have significant negative effects on mental health (Scott et al., 2016). These overload issues can reach across the lifespan and affect individuals in many ways, even more so in the development of children and adolescents (Scott et al., 2016). Those changes can contribute to a variety of mental health problems including stress, anxiety, and depression (Scott et al., 2016).
Adolescents
Adolescents may also experience the increased feeling of social isolation, especially if they already experience mental health symptoms. Web-based interactions and communication can exacerbate social isolation which is why the value of reconstructing a social life in person, as opposed to using social media, acknowledging face to face contact is of great importance (Lal, Daniel, & Rivard, 2017). It is also suggested that adolescents spending time online could be compensating for lack of social skills; this is causing a greater absence of social skills if not using what is practiced online, in face to face communication (George et al., 2018). With these mental health problems increasing, lack of connection and social skills comes the absence of emotional regulation.
George, et al. (2018) completed a study looking at the mental health status of high-risk adolescents after being online and their mental health status the next day to see if emotions caused by digital technology can continue into their next day emotions. The study also reviewed if early access to digital media would cause mental health issues later in life. The study tracked 151 high-risk adolescents, one in three being of low-socioeconomic status; 80% of those adolescents stating that they have a conduct disorder (George et al., 2018). According to Child Mind Institution (CMI), a conduct disorder (CD) is characterized by the callous disregard for and aggression toward others, from pushing, hitting, and biting in early childhood to bullying, cruelty and violence in adolescence.
The finding of the study was that the participants self-reported feeling less anxiety or depressive signs when spending time online (George et al, 2018). Adolescents are finding many coping mechanisms throughout the internet including videos of mindfulness, online counseling, and support groups of students with similar mental health issues. While this is a great use of the internet, the participant also reported feeling symptoms of depression or anxiety one-third of the time when being online (George et al, 2018). A decrease in self-regulation is predicted when technology is used at earlier stages of life (George et al, 2018).
Fear of Missing Out
Through social media, adolescents can maintain their contacts, extend their system of knowledge, or find and exchange information and materials; it also contributes to the structure of their social identity in relation to peer groups, especially in terms of popularity and, therefore, acceptance and sense of belonging (Fabris, Marengo, Longobardi, & Settanni, 2020). The sense of popularity and belonging to certain social groups are labels that adolescents and children at younger ages are starting to have more awareness of and the worry if they fit into that box. This is where the term Fear of Missing Out (FoMO) starts becoming more of a concern. Evidence seems to indicate that adolescents with high levels of FoMO tend to use social media more to compensate for these psychological needs. Along with that, more evidence suggests that FoMO may ultimately have an impact on the well-being of individuals, increasing negative affect and emotional symptoms (Fabris et al., 2020). The increase in emotional symptoms are caused from the heightened feeling that they do not belong and that they are missing out on important shared experiences, along with social media fatigue. For adolescents showing a higher state of FoMO, they could be more sensitive and prone to distress due to experiencing neglect and negative reactions by peers on social media sites. With the increase of being on social media sites due to not wanting to miss anything, comes the fear of not receiving comments or likes or the fear of receiving negative reactions to their posts. This would then trigger compulsive use of social media in order to fulfill their unsatisfied need to connect with others and maintain a positive online social status (Fabris et al., 2020).
Fabris and team spent time researching Social Media Addiction (SMA). It was found that SMA in adolescents has been found to be associated with depressive symptoms, anxiety, low self-esteem, and general psychological distress. Fabris and team hypothesized that FoMO might be positively associated with emotional symptoms in adolescents, both directly and indirectly. The way their team researched this information was by a series of questionnaires that consisted of asking adolescents of their fears, worries, anxieties, experiences, sensitivity to stress, emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior.
The results that Fabris and team found from their study was that the results supported the relationship between FoMO and decreased emotional well-being in adolescents, along with higher sensitivity to stress associated with experiences, to neglect and negative reactions by online peers on social media. Their findings also support the link between FoMO and SMA and identifies a heightened sensitivity to stress, along with neglect by online peers. With this, they were able to interpret FoMO as a specific need and predisposing characteristic of addiction in adolescents, which activates a state of distress when the adolescent assesses the situation as unacceptable for his/her own needs.
Emotion Regulation
When children and adolescents fail to implement positive strategies to help regulate their emotions, increased rates of peer rejection, aggression, antisocial behavior, cyberbully or bullying and social media stress can occur (McLoughlin, Spears, & Taddeo, 2018). Young people have a limited capacity for self-regulation and can be persuaded easily by peers to engage in deviant behaviors. Young people may be at greater risk online when they experiment with social media compared to face-to-face context (McLoughlin et al., 2018). Adolescents that use negative emotion regulation strategies to cope with their anger tend to lean into cyberbullying behaviors to cope. With this increase of internet use as an addition to a coping mechanism, it shows how easily cyberbullying can happen (McLoughlin et al., 2018).
It is helpful to know how the average person can process emotions. Human beings know how to regulate their emotions. They can process how other individuals can affect different emotions, timing, and intensity of emotion, and how to express those emotions (Baillien et al., 2018). People can also review and practice different strategies of emotional regulation. For example, one can change the way they think about an incident or change behavioral response to that incident. Changing behavioral responses to an incident does not help when the incident has passed, but it can help to be aware of behavioral responses for next time (Baillien et al., 2018). The problem is most individuals that participate in cyberbullying cannot understand the negative behavioral response of cyberbullying.
Along with strategies of emotional regulation, individuals find many different coping approaches that work best for them throughout many different situations. The differences in emotion regulation strategies have been described as affective styles and are defined as the person’s constant individual trait that they use in emotion regulation (Baillien et al., 2018). In other words, affective styles are the way one processes their experiences to the way they show their emotional response. Concealing, adjusting, and tolerating are three affective styles that have been consistently found throughout Baillien and the team’s research. Concealing is the tendency to suppress emotions. Adjusting is the inclination to re-adjust for example being able to cheer oneself up after a bad experience. Tolerating is being non-defensive or being able to tell oneself it is okay to feel the way one is feeling (Baillien et al., 2018). Individuals that participate in cyberbullying lack the ability to utilize the three affective styles Baillien and the team have described.
Measuring Internet Addiction
There have been many studies to find the best way to measure social media addiction, smartphone addiction, or internet addiction. One issue of this being that there lacks a consensual definition of the three terms previously stated. As researchers were reviewing ways to measure internet addiction, the realization and development of many scales within assessments were needed. Laconi, Rodgers, and Chabrol (2014) found that there are at least thirteen scales or instruments needed for evaluating internet addiction. The main goal within Laconi and team’s research was to identify all the existing instruments that assessed internet addiction which ended up being seventy-four different studies (2014).
Reliability was assessed through test-retest reliability and internal consistency while validity was mainly evaluated through construct validity which can be projected by considering the relationship between the scale, expert opinion, and other validated measures of internet addiction (Laconi et al., 2014). Validity of tests also looked at the correlation between internet addiction, time spent online, and depression symptoms that were reported (Laconi et al., 2014). After reviewing the reliability and validity of the seventy-four research studies, Laconi and team (2014) reviewed forty-five assessment tools to evaluate internet addiction. The two most notable tests from their research were The Internet Addiction Test and The Compulsive Internet Use Scale with the note that more research and studies need to be completed (Laconi et al., 2014).
The Internet Addiction Test (IAT) was reviewed in more depth by Rosenthal, Cha, and Clark (2018). As of 2015, 95 percent of teenagers in America were online (Rosenthal et al., 2018). Four components were found that characterized Internet addiction: excessive use, withdrawal symptoms, low tolerance, and negative repercussions (Rosenthal et al., 2018). The team reviewed the research of another researcher’s information from a South Korea study, but Rosenthal and team wanted to complete the IAT in the United States.
There was a solid test-retest reliability between IAT summary scores and the 20 question items in IAT with a fair to modest agreement (Rosenthal et al., 2018). Rosenthal and team (2018) completed this study with a group of young adults, not teenagers. There were no individuals within the study that met the team’s definition of Internet addiction, but it could be possible in young aged individuals. It was found that social support and depression diagnosis were found in association with IAT scores (Rosenthal et al., 2018). Results suggested that individuals with a history of depression tended to have higher IAT scores which aligned with other studies in other countries. Along with the correlation with higher IAT scores and depression, it was found that individuals with higher IAT scores also report less social support (Rosenthal et al., 2018).
As Rosenthal and team discussed that a study to review younger aged individuals would be helpful to get a better idea of IAT in the U.S. population, another researcher, Cengiz Sahin, took participates ages twelve to twenty-two years of age to determine if the Social Media Addiction Scale (SMAS) is a usable scale in determining social media addiction. The development of the scale is based on a five-point grading system: definitely not appropriate, not appropriate, undecided, appropriate, and quite appropriate (Sahin, 2018). For participants, the SMAS consists of twenty-nine items and four sub-dimensions on a five-point Likert type scale. The four sub-dimensions being virtual tolerance, virtual communication, virtual problem, and virtual information (Sahin, 2018). The highest score of the SMAS is 145, perceiving oneself to be a “social media addict” and the lowest being 29. There were 998 students that participated in the development of the SMAS. It was determined that the SMAS is a valid and reliable test in determining social media addiction (Sahin, 2018). This is one of the few tools available in determining social media addiction.
It is agreed by most researchers, in this field, that there are very few tools to screen and assess smartphone overuse and addiction. Pavia, Cavani, Di Blasi, and Giordano (2016) focused their research on testing the psychometric properties of the Smartphone Addiction Inventory (SPAI). The results of the research were discovered in reviewing the SPAI correlated well with other studies within this literature review. Five factors were discovered in line with other studies that were noted. The first factor is time spent on a smartphone along with time distortion with difficulty of stopping and devoting more time on a smartphone (Pavia et al., 2016). Compulsivity is the second factor that was revealed. Compulsivity is the discomfort and emotional distress felt by being deprived of using a smartphone which can affect daily life which leads to the third factor of daily life interference (Pavia et al., 2016). Daily life interference refers to the interference of the smartphone use with other daily activities since the smartphone is on their minds. The fourth factor is craving (Pavia et al., 2016). Cravings of being on a smartphone has the tendency to focus a person’s attention from what they are supposed to or should be doing. The last factor is sleep disorders. Being connected to a smartphone has led to later bedtimes, shorter sleep duration, and sleep disturbances (Pavia et al., 2016).
Existing Programming
There are many discrepancies for measuring internet addiction, social media addiction, or smartphone addiction. One point that most researchers can agree on is that programming to help these addictions, mental health, and emotional regulation is greatly needed. One program that has become useful for educators, parents, and students is Common Sense Media. The Common Sense Media website has digital citizenship curriculum for Kindergarten students through 12th grade students, distance learning help guides for teachers, professional development, and so much more. For parents, there are resources that can help them determine which movies, TV shows, and apps are safe for their kids to watch. There is also distance learning help guides as parents, a section on what parents need to know to navigate the internet, and again, so much more.
Another program available for parents, students, and educators is NetSmartz. Like Common Sense Media, NetSmartz is a website that helps parents, students, educators with digital citizenship and online safety. NetSmartz also has an additional website, NetSmartzKids, that kids can go on to play games and watch videos. NetSmartz also has a curriculum for educators to use in school to teach students how to be safe online. Both programs are free for anyone to utilize at any time. Having free programing like Common Sense Media and NetSmartz are important pieces to help combat internet addiction and social media stress with students Kindergarten through 12th grade along with their parents or guardians.
Conclusion
There have been many studies done to look at the relationship between the use of SNSs and well-being. These studies have produced mixed, often contradictory findings, with some studies having found a positive relationship, while others have found the inverse (Vally & D’Souza, 2019). Some researchers have stated that the nature of this relationship may vary depending on several different factors such as intended purpose when using SNSs, the feedback received from other users during their online interactions, and the type of activity engaged. However, the sum of these investigations suggests that the use of SNSs produces a decrease in well-being and promotes negative mood states over time (Vally & D’Souza, 2019).
The literature exploring users’ motivations for willingly limiting or quitting use of the social media accounts has revealed that voluntary abstaining from social media, beneficial consequences tend to ensure, such as reduced stress, enhanced positive affect, and an increase in life satisfaction (Vally & D’Souza, 2019). With this information, it was also found that if the user was not ready or unwilling to abstain from SNS, that they are less receptive to previous stated experiences. Vally & D’Souza (2019) found that the experience of being ‘cut off’ from one’s friends and the FoMO on important events and experiences within one’s social network may further compound the intolerable nature of this experience (Vally & D’Souza, 2019). Mental health concerns are becoming more socially acceptable to discuss, but with Covid-19 endorsing social distancing and isolation, it brings fear of the future with the mental health in children and adolescents with concerns of the increase with social media stress, loneliness, and lack of emotional regulation.