The Antisocial Doctors Podcast
Join Dr. Rebecca Berens & Dr. Sonia Singh as they unpack viral health trends with curiosity, nuance, and compassion. No snark, no shame —just thoughtful conversations about what’s true, what’s hype, why we're drawn to it and how to find calm and clarity in the chaos of social media and online health advice.
The Antisocial Doctors Podcast
Episode 20: Are We Addicted To Social Media?
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In this episode, we dig into the question of whether social media can be addictive—and why this conversation is accelerating now. We start with a recent landmark legal case that put platform design features under the microscope, then zoom out to explore what “addiction” means in medicine and why behavioral addictions matter. We also share a candid moment where we put ourselves through a validated questionnaire and reflect on what it brings up for us as doctors and humans. From brain research to real-life “why can’t I stop?” experiences, we review what the evidence suggests, where it’s still messy, and why abstinence isn’t always the realistic answer. We end with practical, research-informed strategies and ways we can talk about this with patients and families.
00:00 Podcast mission intro
01:14 Social media trial sparks
06:19 Why this moment now
12:05 Defining addiction criteria
15:12 Social media addiction quiz
17:53 Behavioral addiction debate
23:57 Brain changes evidence
34:16 Harms and health impacts
38:07 Benefits and U Curve
40:05 Moderate Use and Connection
41:05 Platform Differences Matter
43:07 Withdrawal Abstinence Evidence
44:54 Tolerance and Slippery Slope
47:11 What Doctors Should Conclude
51:36 Talking With Patients
52:30 Interventions That Work
56:16 Digital Literacy and Regulation
01:00:00 Digital Detox Day Dream
01:05:53 Opt In Design and Nextdoor
01:07:02 Wrap Up and Disclaimer
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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
Rebecca Berens MDand me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
Sonia Singh MDWe're also a millennial women anxious moms and curious humans navigating social media. We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
Rebecca Berens MDThis podcast is meant to be the antidote to your doom. Scrolling, a, solve for the anxiety, stress, guilt, shame, and confusion. That comes from social media's messaging around health. In each episode, we discuss a health related topic, trending on social media with curiosity, nuance, evidence, humility, and compassion.
Sonia Singh MDThis is not your average debunking podcast. We wanna explore not just what is trending on social media, but why? Why are so many people drawn to this? What is the nugget of truth here? What are the facts? What can we learn from this as patients and doctors? No shame. No blame, no snark.
Rebecca Berens MDWe're so glad you're here.
Sonia Singh MDAll right. Hi, Rebecca.
Rebecca Berens MDHi, Sonya.
Sonia Singh MDI feel like I should start this episode by being like. Hi, Rebecca, I'm Sonya, and I am a social media addict. 'cause I feel like that is what I learned when I was researching for this episode. 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. 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. 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. 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. 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. Of course the platforms and the people who represent them totally disagree that's the case. They argue that you can't have a physical addiction to social media the way you can have to tobacco or drugs. 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. And it's really just about how people use or misuse it which is apparently not their responsibility.
Rebecca Berens MDYeah, of
Sonia Singh MDcourse. So that's the inspiration for this episode. I'm curious if you heard about that trial or what you've heard about social media and addiction in the news lately?
Rebecca Berens MDYeah. So I've heard about this trial. I didn't know about the verdict, so I'm actually fascinated that's how it ended up. Because I was not expecting that at all. Yeah.
Sonia Singh MDI think a lot of people weren't.
Rebecca Berens MDAnd yeah, I think it's gonna be. Really interesting to see the impact of that on the behaviors of these platforms. Obviously I think we've all seen, the documentaries of whistleblowers from these companies who have shared these concerns many times.
Sonia Singh MDYeah.
Rebecca Berens MDAnd bringing it into trial and getting that kind of a verdict, I think is definitely gonna have an impact in how this ends up. So
Sonia Singh MDone 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? 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. 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. 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. So they knew that the parental controls were useless and just, performative.
Rebecca Berens MDYeah.
Sonia Singh MDAnd that details on that stuff I found very difficult to find. So anyway.
Rebecca Berens MDInteresting. I'm gonna have to do my own deep dive. I guess we'll get into a lot of it today, but it
Sonia Singh MDwarrant some deep dive.
Rebecca Berens MDI'm gonna be searching. 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.
Sonia Singh MDYeah, I didn't go too far into that specific case 'cause I had a lot of other ground to cover for this. Of course for this episode. But it may be worth, some digging. 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. 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. Inherent in that claim is also that social media is designed to be addictive and that social media can cause significant personal harm. Like when we talk about addiction, it's typically to a substance that people continue using despite harm. 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. Of note, we did do a previous episode on social media. The very first full episode we recorded was, is social media Making us unwell? And that episode was really focused on health information on social media rather than just. The algorithms and the platforms generally. 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. There's always been complaints that the content is harmful. But there's some legal protections against people of platforms being sued for the content that other users are posting. So they were, essentially immune to a lot of this litigation for a long time. But now this particular case is really pointing to the algorithm itself and the design features of the platform being harmful, which is interesting. And so that's what this episode is gonna focus on. 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.
Rebecca Berens MDI think this is come up a lot, but I think COVID was an inflection point for a lot of people, I think. 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. I think it gave a lot of parents a window into what was happening in a way that maybe they didn't have before. 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. And so I think, when you're hearing it directly from the person who's been affected, it's it's very compelling. So I think those are two theories that I have. And then also I think just the time it takes for litigation to go through, It's not as if this just happened. This has been building in the background for a while, but like the legal process is slow. Yeah. 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.
Sonia Singh MDI totally agree with everything you just said. And one of the points on my list was that. 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. So they're coming of age, they're entering the workplace. And that's the first generation to have really been born into social media from the time they were pre-adolescent. And so I think, there's been a lot of talk, not just from Gen Z, but about them Yeah. From
Rebecca Berens MDother generations. Yeah.
Sonia Singh MDThere's these two book big books over the last few years, the Anxious Generation by Jonathan Het and Dopamine Nation by Anna Lemke. Both really interesting books, but it's funny, when I heard. About the book Anxious Generation. I was like, I don't need to read that. I'm living it. And then I realized that they were talking about Gen Z and I was like, oh, okay. I can read that without being too triggered.
Rebecca Berens MDI was pretty triggered. I dunno. For me, I was like, oh my gosh, my children, what's going to happen? But
Sonia Singh MDyes. 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
Rebecca Berens MDYeah.
Sonia Singh MD10 years later.
Rebecca Berens MDI feel like it was, we were the unique generation in that we remembered a time before
Sonia Singh MDwhen there wasn't. Yeah.
Rebecca Berens MDAnd so it's maybe more jarring for us. Yeah. But also the development effects on us were different that it was for them.
Sonia Singh MDYeah.
Rebecca Berens MDHaving it at such a younger age.
Sonia Singh MDYeah. Do you, I remember a time, so I think I was in medical school when I got Instagram and I remember a time when. Your Instagram feed would end. Yes. It would be like, that's it.
Rebecca Berens MDLike you
Sonia Singh MDget, you would get to the bottom of it and you were like, they were like, Nope, no more for you
Rebecca Berens MDto put it away.
Sonia Singh MDYou put it away, you put it down. It's crazy that doesn't happen anymore. Anyway, so a couple other theories that I came up with. I think one is just that social media use is so pervasive. We are all having the experience we're all feeling this or seeing this in some way. 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. So he is seeing the effects of it even though he's not on it. There's a study that found that 71% of Americans are using Facebook. I think for teens, the number is 80 something percent. So I think one is just like we're all seeing and feeling the effects. Another thing is that the platforms have gotten progressively more effective. We were just talking about how the feed used to end and now it's infinite scroll. You can go on and on forever. 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. So whatever bizarre niche you like are interested in, there's gonna be content around it. And so I think they've just gotten very good at keeping our attention. 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. It was
Rebecca Berens MDlike an ashtray on
Sonia Singh MDLD. 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. And healthy is perhaps not as healthy as we thought it was. And so I think, we're following a similar pathway with some of this social media stuff. 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? And I think it's also evidenced by the rise of technologies to help us stop using these technologies. Sometimes I wonder is it normal? How hard it is for me to not use these things? 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. I'm like, okay, clearly there's other people in this boat and this is a common problem.
Rebecca Berens MDYeah. Yeah. 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? Am I clearly exhibiting this addictive behavior probably. 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.
Sonia Singh MDYeah.
Rebecca Berens MDNo matter how hard you might try. 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. Yes. Actually, I just
Sonia Singh MDhad 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. 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. 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. It means a specific thing. We shouldn't throw the word around willy-nilly. And that should really be reserved for a very particular pathology. And this is not that. So let's just talk about what addiction is. 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. So that is a more fleshed out, formal definition of addiction. However, the medical community is moving away from the term addiction and moving towards a more general neutral term, which is substance use disorder. 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. But, the other end of that spectrum could just be like. Compulsive use or problematic use or substance abuse. So as with any diagnosis in medicine, there's very specific diagnostic criteria for something to be considered a substance use disorder. 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. And the categories for this are impaired control, social impairment, risky use, and pharmacologic criteria. 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. Okay. 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. Failure to fulfill major role obligations at work, school, or home. Continued use despite persistent social or interpersonal problems, important activities given up or reduced because of substance use. Sleep, I think is like popping up in my mind.
Rebecca Berens MDYeah.
Sonia Singh MDRecurrent 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. So tell me how you feel when you hear that list.
Rebecca Berens MDYeah 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. We just talked about persistent desire, unsuccessful efforts to cut down or control, use. Yes. Literally purchasing devices to help us, to help
Sonia Singh MDyou not use
Rebecca Berens MDyour
Sonia Singh MDdevices. Yes.
Rebecca Berens MDI think this is definitely very applicable. Yeah. 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. And I'm like,
Sonia Singh MDokay. 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. So this is not diagnosing anything, but it is a validated questionnaire in that results are very consistent across administrations of this test. And it seems to be measuring something, we'll call it problematic social media use. Okay, so I'm gonna ask you the questions right now here live and you're gonna answer them. Oh
Rebecca Berens MDman, this is gonna be embarrassing.
Sonia Singh MDOkay. Okay. So the choices are very rarely, sometimes, often. Very often you spend a lot of time thinking about social media or planning how to use it. So very rarely, sometimes, often, or very. I'm gonna say sometimes. Okay. Next is you feel an urge to use social media more and more? Very rarely, sometimes, often, or very often.
Rebecca Berens MDI'm gonna say often.
Sonia Singh MDOkay. You use social media in order to forget about personal problems, don't we all?
Rebecca Berens MDYeah. I'm gonna say often.
Sonia Singh MDOkay. You have tried to cut down on the use of social media without success? Very often. Very often. Okay. I can answer that one for you. You become restless or troubled if you are prohibited from using social media.
Rebecca Berens MDOkay. What was the, what were the lower categories?
Sonia Singh MDVery rarely, sometimes.
Rebecca Berens MDOkay. I'm gonna say
Sonia Singh MDthis is getting at withdrawal, right?
Rebecca Berens MDYeah. Yeah. And I, it's interesting 'cause like I was worried about that when I got the brick. Yes. But it was not as bad as I expected. Okay. I was pleasantly surprised. I'm gonna say rarely,
Sonia Singh MDmaybe. Okay. Okay. Okay, last question. You use social media so much that it has had a negative impact on your job or studies?
Rebecca Berens MDI'm gonna say sometimes.
Sonia Singh MDOkay. Let's see what you got. High addiction. Yeah, high level of addiction.
Rebecca Berens MDOkay. This is not surprising to me in the least. So
Sonia Singh MDI thought before I did any of this, that I feel like I'm on the spectrum of social media usage. I feel like I'm in a less than average category. 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. 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. But even I had moderate addiction, so I was like, are we all addicted
Rebecca Berens MDto you? I probably,
Sonia Singh MDAnyway, one of the big okay. So anyway, we're both addicts. Yeah. We've accepted it. Okay.
Rebecca Berens MDWhich I think we should talk about that term also, but we can get to that.
Sonia Singh MDOkay. Fair. I wanna hear that criticism down the road. Yeah. Okay. 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. And then you have this physical withdrawal syndrome and you have this physical tolerance. 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? But I think there's a couple of counter arguments to that. So one is there's already precedent for the this, which is gambling. Okay. So gambling is a behavior, it's not a substance. And it's a behavioral addiction. 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. Rather than gambling addiction. But they found that the research had evolved on this. 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. And so in the DSM five, they renamed it as gambling disorder and categorized it as an addictive disorder. 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. So I guess the bottom line that I take from a lot of this discussion of criteria and naming is just that. The medical community is not taking these terms lightly. 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. This is just happening for gambling and gaming, which have been around for a really long time. As you said, these things move really slowly and this is a relatively new technology. 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.
Rebecca Berens MDYeah.
Sonia Singh MDAnd then eventually, I bet you that we'll get elevated to the level of social media use disorder.
Rebecca Berens MDYeah.
Sonia Singh MDSo that's my prediction. And it's gonna be immortalized in this podcast. So someday I'll come back and say, I told
Rebecca Berens MDyou we'll cite.
Sonia Singh MDOkay, so that's point number. Do you have any thoughts on that before I move
Rebecca Berens MDon? Yeah, I totally agree and a lot of what comes up for me is like the controversy around the concept of food addiction. Which I think has a lot of similar concerns around it and using that term especially. 'cause food is not something you can abstain from.
Sonia Singh MDRight.
Rebecca Berens MDYou can abstain from gambling, you can abstain from social media playing video games. You can abstain from social media, you cannot abstain from food.
Sonia Singh MDYeah.
Rebecca Berens MDBut I think there's, there are some behavioral things around food that sometimes can approach addiction like behaviors. And so there's a lot of controversy on that topic also. 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.
Sonia Singh MDYeah.
Rebecca Berens MDBut it would actually really limit your. Social interaction.
Sonia Singh MDYeah.
Rebecca Berens MDNowadays.
Sonia Singh MDYeah.
Rebecca Berens MDSo I think it's, it just brings up a lot of similarities for me of that conversation. And maybe we should do a whole other episode about the concept of food addiction.
Sonia Singh MDYeah.
Rebecca Berens MDBecause I'm seeing a lot of overlap there.
Sonia Singh MDYeah. I think that would be, is that what your thoughts were around the word addiction
Rebecca Berens MDthought? I think so. I think for me the term addict is, there are some people who use that term to describe themselves and find it useful. And then I think it also becomes an identity that Can be potentially harmful in someone's recovery. And so I think we just have to be very careful about using that term. 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. And that ident identity to me is helpful.
Sonia Singh MDYeah.
Rebecca Berens MDBut I think it also is a term that is weaponized societally is you're just like that. You're never gonna change. You're just a bad person. It has a lot of negative connotations to it, so I'm just very careful with that term. Again, like if a person finds it helpful for themselves.
Sonia Singh MDYeah.
Rebecca Berens MDI 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. And then even if they are saying about themselves what does that mean that you believe about yourself? 'Cause it's, it, I think it can become an identity that's really hard to shake. And I see this a lot. There's so much overlap with eating disorders and substance use disorder, neurobiologically. Yeah. And I see this a lot with patients and I think this happens with the eating disorder identity. Like I have an eating disorder, so like this is how I am. And I can never change, and I can never recover. And
Sonia Singh MDyeah.
Rebecca Berens MDAnd I just don't believe that to be true. It's difficult, but it's possible. And I think if we use that term as an identity, we can really limit some people from being able to reach recovery. So I just don't like using the term myself for other people. And again if some, there's someone listening to this podcast who describes themselves that way and finds it helpful. Yeah. I think that's totally up to you. 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.
Sonia Singh MDTotally hear you. So I'm gonna say we are suffering from social media addictions.
Rebecca Berens MDYes.
Sonia Singh MDOkay.
Rebecca Berens MDI, and I would say I am someone who I know has a, has the neurobiology. To. Have addictions. I know that about myself.
Sonia Singh MDYeah.
Rebecca Berens MDI, it's, it is run strongly in my family. It is like the experience of having an eating disorder. I understand what addiction feels like.
Sonia Singh MDYeah.
Rebecca Berens MDIt's, and so I think that I think, for me, I actually don't mind it if someone uses that term about me. 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.
Sonia Singh MDGot it. Yeah. Okay. So let's go through now. Okay. So first we talked about the fact that yes, behavioral addiction is a thing that seems to exist already. Exists with gambling. 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. 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. 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. So the first study was called social media use and Early adolescent brain Structure, the A, B, CD study. So they looked at over 7,000 participants, ages 10 to 13, and had them. Self-report, their social media use. And then they also had them do a social media addiction questionnaire. Actually, I think it was the same, the Bergen questionnaire, the same one you just did. 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. And the brain regions that had the most differences were the prefrontal cortex, the temporal lobe, the occipital lobe, the and the parietal lobe. And so these are basically all areas that correspond with not only our reward system, but executive functioning, visual processing, and attention networks. So that's interesting. Yeah. It seems that in these kids, now the question of course is Is this correlation or causation? Yeah. Are these kids who have brains that already look like this, just using the social media more because of those underlying differences? Or is it the social media that's driving that? So this next study tries to answer that question 'cause it's more longitudinal. So this one is called association of Habitual Checking Behaviors on Social Media with Longitudinal Functional Brain Development. And this was in JAMA Pediatrics. This was actually over and over in a lot of articles and studies that talked about this topic. So they took a cohort of 169, sixth and seventh graders from three different public schools in nor rural North Carolina. So these are American kids, followed them for three years and did functional MRIs on them every single year. 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. And then And along with that, they were also self-reporting how often they were checking social media. 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. So it's hard to actually accurately gauge how much time you're using it. 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. So adolescents who checked. Social media more habitually also showed initial hypo activation in some of those areas. So like on the baseline study, they, those areas were maybe less active, but. They had over time increasing sensitivity in those reward related regions, suggesting that the brain becomes tuned to anticipate social feedback. And so this is the same pattern that's observed with a lot of different addictions to other substances. 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. And so maybe those kids are seeking more of that dopamine hit from checking the social media frequently. And one of the design features about social media that makes it such a dopamine hit is the unpredictability of it. Yes. You post something and you don't know if anyone's gonna like it or how many people are gonna like it. You don't know when you're gonna get a notification. You don't know when you're gonna get a DM from somebody. And so it's that unpredictability. The same with gambling that makes it, yeah. Dopaminergic basically,
Rebecca Berens MDwhat is that psychological service like variable response or something like that for Yeah. Yeah, and it's, this sort of supports what we're saying, there's initial predisposition, right? Maybe there's something about the brain that is different at baseline. But then it changes in response to the input habitual
Sonia Singh MDchecking.
Rebecca Berens MDThe habitual checking.
Sonia Singh MDRight.
Rebecca Berens MDAnd yeah, so it's it's not just that using social media causes this to happen to you. Maybe you have a predisposition for it and you're more susceptible.
Sonia Singh MDRight.
Rebecca Berens MDAnd then you are someone who becomes. More attuned and then Yeah. Worsens over time
Sonia Singh MDright,
Rebecca Berens MDyeah.
Sonia Singh MDYeah. And one of the things I was listening to about this, they kept drawing these analogies to gambling. And then, they mentioned how even just the mechanism of pull down to refresh something is exactly a slot machine. What I thought about that, I was like, oh my God. 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? Some good news gonna come to my inbox. Okay, so moving on to the next study, which I thought was one of the most interesting. So this one. Was very small. So I will admit this is a very small study. So this was 20 college students that were recruited and then randomly assigned to either a control group or a social media group. 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. Yeah, I've
Rebecca Berens MDnever heard of that.
Sonia Singh MDIt'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. 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. Including the prefrontal cortex, which is the area that we're interested in for this type of stuff. Basically they had all the participants do wear the cap and do this executive functioning test. So it's a test of working memory and inhibitory control. And then they also had them fill out an emotion questionnaire that was trying to get a sense of their emotional state. 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. So no emotional salience basically. And then they all did the same executive functioning task again, and then also completed the same emotion questionnaire again. Of note, they screened all 20 patients with the social media addiction questionnaire that we did, and 55% qualified as addicted to social media. So we're not alone. 80% of the social media group so th this was a caveat here. Yeah. 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. So there was a very significant,
Rebecca Berens MDwhy didn't they split
Sonia Singh MDthem? Did they do this after the fact? 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,
Rebecca Berens MDbecause then that makes this annoying
Sonia Singh MDthe results. Yeah. Hard to interpret. Yeah. And and when the group is so small, like this can happen,
Rebecca Berens MDright? Yeah.
Sonia Singh MDSo anyway take all of the results here with a grain of salt. 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? Okay. The delta. 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. But as we learned from the previous study, they have both a different baseline. Yeah. And they have a different delta.
Rebecca Berens MDYeah, that's the thing. I'm like, if you're baseline more predisposed right. Then you may have a larger effect size anyway. Even if, yeah. So you
Sonia Singh MDare correct, but you are correct. Okay. But the social media group had reduced inhibitory control following exposure to social media. 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. 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. So basically they had to expend more effort to do the same executive functioning task following the intervention, which was scrolling the social media. 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. So basically it was harder to do the task. Their working memory was poor and their ability to in inhibit, responses they did not wanna have was also challenge. There was no change in emotional state based on the questionnaires pre or post intervention or between the groups. So the bottom line was that even brief passive social media use, like this was only 15 minutes. And think about how many, on average minutes are being spent per day on these platforms. And it was completely passive. They were not engaging anything may impair cognitive function, including inhibitory control and working memory. And you know what this study made me think. So again, this is not great, it's a small sample size and there are some issues with the the comparisons between the groups. But this just made me think of brain fog. So like brain fog was not a thing that anybody talked about 10 years ago. No one came in and was talking to me about their brain fog until maybe 2018. I started hearing a little stuff about brain fog. But after the pandemic, it's just so much brain fog, right? When people are describing brain fog I think these are some of the things that they're describing.
Rebecca Berens MDYep.
Sonia Singh MDAnd 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,
Rebecca Berens MDit's certainly not helping, I don't wanna suggest that there's nothing biological else going on, but it's certainly not helping.
Sonia Singh MDNo I totally there. Brain fog is a non-specific symptoms that it can be caused by a variety of things. 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. When they come in and they're like, they're usually just what about my thyroid? And what about perimenopause and what about anemia and what about my blood sugar? No one's what about my social media use? Do you think that's a problem? And I think, that we should really be thinking about that. 'cause I, I think there's evidence that certainly for certain people there's probably a pretty significant effect on cognition.
Rebecca Berens MDYeah, absolutely.
Sonia Singh MDOkay, so the next, question to ask about whether we can call this an addiction. So we've shown that even though it's not a pill, it's not a substance that you ingest. It is having these very powerful biological and physiological effects. Now the next question is, but is it really causing harm or impairment? And I think that's a hard question to answer. We don't wanna pathologize relatively human behavior that's just happening in response to a new technology. I tried to summarize some of the data on the harms of social media. So obviously there's a lot of studies around mental health, but most of these are showing correlations, not causations. And these associations, even when they exist, are relatively small. But social media use has been associated with various negative outcomes. 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. There are several meta-analyses that have shown positive associations between problematic use. So that's looking at only people who are using heavily or are scoring high on some of these questionnaires. So that is associated with depression, anxiety, and sleep problems, and just general negative associations with wellbeing. All those meta-analyses note that it appears to be a bi-directional relationship where patients who are already depressed may. Then driven to use their social media more and then that may then worsen their depression. So it's like a chicken or the egg situation where it's hard to know, what was the initial trigger?
Rebecca Berens MDYeah.
Sonia Singh MDPotential mechanisms for why they would cause that harm. 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. And then that is leading to downstream effects on mood and wellbeing. But then the other potential mechanisms of harm are cyber bullying exposure, social comparison poor emotional regulation displacing in-person social interactions. 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. I would add medical misinformation to that.
Rebecca Berens MDYeah, absolutely.
Sonia Singh MDSo the content itself can also cause you harm. 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. That study I was surprised by some of those findings and to me. 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.
Rebecca Berens MDYeah.
Sonia Singh MDThe kids that are maybe spending the most amount of time on social media are maybe just being neglected or,
Rebecca Berens MDyeah, 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. And you're seeing your kid on social media all time and
Sonia Singh MDyour child's going to school,
Rebecca Berens MDright. And Right. 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. Yeah. Or like you said, a lot of these risk taking behaviors are probably associated with an underlying predisposition Yes. For more risk taking and dopamine seeking behaviors at baseline. Yes. So yeah, there's.
Sonia Singh MDThat's what
Rebecca Berens MDit, not necessarily causative here.
Sonia Singh MDYes, I agree. Beyond the mental health side effects, there's also potential physical health side effects. So social media use has been found to correlate with sedentary behavior, lower physical activity, and higher cardiometabolic risk. A lot of people are just laying around.
Rebecca Berens MDYeah.
Sonia Singh MDWhen they're looking at this.
Rebecca Berens MDIt's a displacement thing again, right? Like you're talking about if it's displacing sleep, it's also maybe displacing you, walking over to a friend's house. Yeah. Or just like even walking around your house. It doesn't have to be, I'm going to the gym instead of going on social media. It could just be like normal day to day movement.
Sonia Singh MDOther smaller stuff or things like eye strain, musculoskeletal pain, headaches, things like
Rebecca Berens MDthat. Tech neck.
Sonia Singh MDYeah. I want to mention briefly before we move on, that there are also studies showing benefits of social media for many users. 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. 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. So there was a cohort study in Australia, which was huge. It was like over a hundred thousand adolescents, grades four through 12. 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. So like they're very aggressively looking into this. Yeah. And regulating it. 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. And these were a little bit different for boys and girls. 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. And was actually worse than excessive use when you were a late adolescent. 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? Is because you're already depressed? 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.
Rebecca Berens MDYeah. And that's really interesting. 'cause I do think that my gut reaction is oh my God, no social media,
Sonia Singh MDnone. Yes.
Rebecca Berens MDAnd that's probably not the right answer either. And even like I said for myself, like at the beginning, you. Can you abstain from social media? Technically yes, but it would actually be really impactful for me to be completely off social media.
Sonia Singh MDYeah.
Rebecca Berens MDI 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
Sonia Singh MDYes.
Rebecca Berens MDThat we make, like you and I would not have met.
Sonia Singh MDYes.
Rebecca Berens MDThis
Sonia Singh MDpodcast would not exist.
Rebecca Berens MDAnd it's not. And there's so many communities within social media that I would never have had access to or people I would never have met. Yeah. Things I would never have learned had I not had that.
Sonia Singh MDYeah.
Rebecca Berens MDThat would've been really harmful. Or not allowed me to, have what I now have in terms of friends and family and business connections. But yeah, it's. The answer is probably not just cut it all out, but how do we make it safer?
Sonia Singh MDWe will talk about the answers they're coming up. Okay, so I wanted to talk about another study. 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. 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. And basically what they found was passive usage of so of Facebook was negatively correlated with wellbeing. 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. Through social support was their theory. Active usage of Twitter was positively related to satisfaction with life through social support. Whereas passive usage of Twitter was negatively associated. Again, they theorized due to upward social comparisons. TikTok was apparently not associated with wellbeing in either direction.
Rebecca Berens MDFascinating.
Sonia Singh MDDon't believe that. But
Rebecca Berens MDyeah, I don't believe that either, but they're fascinating.
Sonia Singh MDSo anyway that's, this
Rebecca Berens MDwas, this was early TikTok though.
Sonia Singh MDOh, yes. This was conducted in 2020.
Rebecca Berens MDYeah.
Sonia Singh MDLike during the, during. So TikTok,
Rebecca Berens MDwe need to reassess TikTok.
Sonia Singh MDYeah. Okay. Who will revisit that?
Rebecca Berens MDSo someone else can do that study and we
Sonia Singh MDOkay. 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.
Rebecca Berens MDDid you find anything on YouTube? Because I wonder a lot of I feel like boy, social media use tends to gravitate more to towards YouTube. YouTube, which is not technically social media, but it is
Sonia Singh MDi'm curious. Also YouTube was definitely considered social media and the trial
Rebecca Berens MDmentioned. Okay good.
Sonia Singh MDYouTube 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. We are a streaming company. They're just like, don't lump us in.
We'll
Rebecca Berens MDsay, turn off your comment section and then you will no longer be social media.
Sonia Singh MDSo yeah, I don't have any specific data around YouTube, but. Okay, so the next question is, but is there withdrawal or tolerance? 'cause that is one of the features, that we think of with addiction. 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. They did not really find any clear pattern for social media use. 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. And then they were tracked on various measures of anxiety, depression, and overall wellbeing before and after the intervention. And they did see significant improvements in all of those metrics. And I think there was a dose dependent relationship where like. The more you were using initially the bigger the response you had to the intervention or the week of abstinence. But then later there was meta analysis that looked at a few different pooled studies that looked at abstaining from social media. 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. So the data on abstinence from social media is actually not like a slam dunk. Oh, it helps. And I looked at the funding for these studies 'cause I was immediately sensitive and they were like public grants and stuff. Okay. So there's nothing there. Okay.
Rebecca Berens MDBut that's interesting 'cause that's one of the criteria,
Sonia Singh MDright? So it is one of the criteria, but you don't have to have all of the criteria.
Rebecca Berens MDRight.
Sonia Singh MDFor a substance use disorder.
Rebecca Berens MDAnd I wonder because like I said, when we talked about, my horrific results at the beginning I was pleasantly surprised. I thought I was gonna have more withdrawal type behaviors. Yeah. When I stopped when I put my brick up.
Sonia Singh MDYour experience cor correlates with some of these studies, which are like, yeah. There's not really like a clear withdrawal syndrome, cravings and boredom or like the two things that were identified as potential
Rebecca Berens MDYeah.
Sonia Singh MDWithdrawal.
Rebecca Berens MDBut I feel like there is tolerance.
Sonia Singh MDYeah. I would
Rebecca Berens MDsuspect 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
Sonia Singh MDYeah.
Rebecca Berens MDSubstance or behavior to get the same effect. And I do strongly feel there is tolerance.
Sonia Singh MDYeah.
Rebecca Berens MDBecause I had a complete block on social media for several weeks. 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. And I did find that that usage increased substantially. 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. But it's oh, increased over time and that I don't know, I feel like there's tolerance in my n of one
Sonia Singh MDI
Rebecca Berens MDdon't know. That's the study. We're n of
Sonia Singh MDtwo. No, we're n of two. '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. And then I did the same thing where I was dipping my toes in just occasionally to do, and initially it was very manageable. I was only doing it on my desk, like not desktop, but only doing it on my computer. And, but then it just, it's a slippery slope. Yeah. And now I'm back to where I was probably a year ago, except I'm not producing much content. I'm just passively consuming
Rebecca Berens MDit, which is possibly worse, which is according to studies. But yeah. So I also did the same thing where I was like, I'm only gonna use Facebook on my desktop. 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. And it was working. And then I kept Facebook Messenger on
Sonia Singh MDmy
Rebecca Berens MDphone. Same. 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. I could still get it. I was like, this is insane. I not get to it.
Sonia Singh MDYeah.
Rebecca Berens MDWithout taking Messenger off. And Messenger is again, I use it to talk to people.
Sonia Singh MDPeople
Rebecca Berens MDYes. I know that I wanna talk to,
Sonia Singh MDI know
Rebecca Berens MDlike 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. I'm just like, this is very frustrating.
Sonia Singh MDOkay, so towards the very end here, I have some research on effective interventions that we can
Rebecca Berens MDOkay, great.
Sonia Singh MDBefore we get
there,
Rebecca Berens MDI can't wait to hear that
Sonia Singh MDbefore we get there. Yeah. You're gonna be happy.
Rebecca Berens MDOkay.
Sonia Singh MDBefore we get there, I wanna briefly talk about. Okay, so what do we learn from this as doctors and humans? What conclusions do I draw from all of this research? You know what I would with the bottom line here is I would say right now there's no formal diagnosis here. There's no official diagnostic criteria, there's no formal definition around this. But clearly there is growing evidence that there is an entity of problematic social media use. 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. 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. 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. But. I think anything in excess can be bad. You can over exercise and you can over hydrate and you can do all these things to excess. 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. And right now the data on stopping our social media use is not really there. But I do think eventually there will be a diagnosis associated with this. 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. 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. For example, meth, it's really hard to be. In the depths of a meth addiction and for it to not impair your life. 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. Yeah. And oftentimes you can avoid visible effects of it. 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. Yeah. And so often it's very easy to mask and to not have any outward signs of it. Like you and I are highly functional people,
Rebecca Berens MDarable. But Sure.
Sonia Singh MDI think, we're professionals and we run businesses and we have small children and we,
Rebecca Berens MDwe appear functional.
Sonia Singh MDWe show up on time for stuff, you we're functioning right. But I think our level of social media use and addiction would have to get. Pretty extreme. Yeah. 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. And that, my brain feels like it's rotted, like
Rebecca Berens MDYeah.
Sonia Singh MDI don't know. So I think it's something where it's just not as visible of a, of an issue. And so it might take a longer time. It's already taken us a long time with alcohol, so it might take an even longer time with something like that.
Rebecca Berens MDAnd it is hard to study also. '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.
Sonia Singh MDOh
Rebecca Berens MDand that's so hard to study. 'cause when you're polarized, you like, don't buy into it, I don't know. But I think that, I think it would be hard to find someone who didn't agree that social media has contributed to polarization.
Sonia Singh MDYeah.
Rebecca Berens MDBut it's very hard to prove. Yeah. And study, but that is a larger societal harm that's not individual. And yeah it's just, it's
Sonia Singh MDsuch a tricky, we show a separate episode on that.
Rebecca Berens MDYes.
Sonia Singh MDBecause it, like on ra, on polarization and radicalization
Rebecca Berens MDYes.
Sonia Singh MDLike how the design of the algorithm basically pushes you towards those extremes, you
Rebecca Berens MDknow? Yeah. Yeah. That could be a whole conversation.
Sonia Singh MDThat's true. That did not come up as much in the kind of the research around general harms. Yeah. Actually it's interesting that wasn't even mentioned. 'cause I think that's a really, I think it's
Rebecca Berens MDto
Sonia Singh MDstudy new phenomenon too. Yeah.
Rebecca Berens MDBut it's hard to study.
Sonia Singh MDYeah.
Rebecca Berens MDBecause there's so many things that influence someone's, Beliefs system. Yeah. You can't be like, oh, it's all 'cause of social media. But I think we could all say it's definitely partially because of social media.
Sonia Singh MDYes.
Rebecca Berens MDI think we all intrinsically know that, but it's hard to prove it scientifically yeah.
Sonia Singh MDSo anything else you wanna say in terms of what you take from this or what you learned from this?
Rebecca Berens MDNo, I think, I think I, I felt a lot of this intrinsically and I felt, I'm glad there's some evidence behind it.
Sonia Singh MDYeah.
Rebecca Berens MDAnd yeah. And now I just wanna know how can we fix it? 'cause I personally need to know. Yeah. And then, yeah, I do think it's important to be able to talk about this from a very scientific perspective with patients. Yeah. Because it is a hard topic to broach also.
Sonia Singh MDYeah. Yeah.
Rebecca Berens MDYeah.
Sonia Singh MDSo how would we talk about this with our patients and how does this information change our practice? So I would say like just talking to patients about their social media use. How much, how often, how are you feeling about it? Have you wanted to cut back? Have you tried to cut back? 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. That might tell me a lot about what's going on with your
Rebecca Berens MDhelp. See that was actually the thing that when I saw mine, I was most horrified by that prompted me to get the brick.
Sonia Singh MDcause
Rebecca Berens MDI find that's how it affects me is it's not that, it's just the time just evaporates. And I'm like, I went on here to do a specific thing.
Sonia Singh MDYes.
Rebecca Berens MDAnd it's 30 minutes later. How did I end up here?
Sonia Singh MDYes.
Rebecca Berens MDYeah. Oh my gosh. I do wanna see that because I did start asking about it. I think we both around the same time.
Sonia Singh MDI
Rebecca Berens MDcan't remember why we both added it to our intake forms.
Sonia Singh MDYes.
Rebecca Berens MDAnd so the conversation does come up, but yeah, it's what do you do with that information?
Sonia Singh MDYes. Okay. So that's the next question. So how do we, what do we tell them? How do we decrease, use effectively, what interventions work for that? So as with most things, a multifaceted approach is the most effective, a combination of approaches. So step number one is screen for underlying disorders like anxiety, depression, A DHD. So like we talked about, there's a bi-directional relationship with some of these things. So you don't wanna miss, you can't. Blame everything on the social media. You wanna miss an underlying diagnosis that we have effective treatments for. So screen for those things and treat them. 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. 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. So it helps them limit use or engage in a more healthy way. 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. Incorporating breathing exercises and compassionate self-talk to limit usage. And there were a few small studies on digital detox apps. 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. And they have been shown to reduce the overall time spent. 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.
Rebecca Berens MDAnd 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. And that's the thing with so many of these apps, you can override them.
Sonia Singh MDI'm curious if you ever find yourself binging once you get back to the brick.
Rebecca Berens MDNo. So it's actually interesting. I un bricked myself. Somewhat recently because I needed to share a story from someone for a podcast episode I did. And I couldn't do it from the desktop. 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. Oh. Even though I am un bricked, which now I've spoken it into existence, I'll probably do it. Okay. So I'll go brick myself. You're
Sonia Singh MDhaving a craving right now.
Rebecca Berens MDBut but yes I was like, oh, this is great. 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. And I do find that that sort of tolerance effect, like once I'm in, I just keep
Sonia Singh MDYes.
Rebecca Berens MDKeep going. 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? I haven't had that experience with Instagram, which has been great, but but yeah.
Sonia Singh MDThat's good to know. Yeah. I guess so. Yes. 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. 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. Of I have to do this thing, or I have to post in this group, or I have to do whatever. And now I'm totally back to my baseline, which is get bored, open it. Nothing interesting. Okay. Lame didn't get a, didn't get a dopamine hit from that. 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. And then I'm like I gotta keep looking because no matter what the outcome, you just are motivated to keep going to it.
Rebecca Berens MDThat's a variable response
Sonia Singh MDtraining. It's just, it's crazy. Anyway, okay. So digital detox apps do seem to work CBT and CBT based strategies, including mindfulness based intervention, self-compassion interventions. Those seem to work. 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. And I was reading these and I wanted to like, I felt like I was at a spoken word and I wanted to snap. I wanted to snap for them. I was just like, yes. Preach a p. This is amazing. So they're of the attitude that this is the ecosystem our children are growing up in. This is the world now and abstinence is going to be really challenging. And if you think about, a teenager who every single friend of theirs is on social media Yeah. And you're telling them you are not going to be there can be a social isolation to that, yeah. Like that. There is potential harm in that too. So their attitude is really about teaching children digital literacy. And this is around children, but I think this is an approach we can take with our adult patients too. I don't see why it doesn't apply. So they go through all of these different there's a big table that includes more things than just social media. They talk about screens in general, but I just highlighted the ones that are related to social media. 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. So they're referring to teaching them, why they might see really scary stuff a lot. 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? Yeah. 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. Holding companies accountable for manipulative algorithms that amplify harmful content. So that's around the algorithms around engagement prolonging design. So those are things like auto play and infinite scroll. They say ask about how children decide when they're done with digital media. Talk about digital design features that make it hard for them to stop. So educate them about the fact that oh, you know how this video just. 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. For misinformation. 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. So when I read those I was I feel like that's what we're doing with this podcast. Yeah.
Rebecca Berens MDWell, specifically the misinformation one for sure. That's our whole point. 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. And there's so many settings that are so hidden and so I don't even know what they all are. It should be easier to just be like, make this less, less addictive. Yeah. 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. All those sorts of things. It's so difficult Yeah. To use these safeguards. It should be easier. Yeah. And that's where maybe that regulatory stuff comes in, but it's like we are all individually fighting this really difficult battle. It would be so nice if the companies would just make it a little bit easier for us. And rather than, claiming that there's no problem and this is user error, yeah. It's it's obviously not,
Sonia Singh MDbut 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.
Rebecca Berens MDYes. Yeah.
Sonia Singh MDI, I think a lot of people haven't even. Like I said, like patients will come in saying, I'm not sleeping enough. 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. Oh, I had another thought on that. Oh, okay. I was gonna say, one of my dreams now that I've decided is to have a digital detox day.
Rebecca Berens MDOh my gosh.
Sonia Singh MDHow, first of all, first I was just thinking of this on a, for my practice or for you. And I could do it. We could do I was
Rebecca Berens MDgonna say, when we, when can we do
Sonia Singh MDthat? We could schedule it. Yes. 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. '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. Unsubscribe from lists, turn off notifications. 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.
Rebecca Berens MDYes. Yes.
Sonia Singh MDThe alert fatigue that we're having. And then I was thinking like, wouldn't it be fun if that was just like a national day where everybody was
Rebecca Berens MDyes. Digital detox
Sonia Singh MDday. Yes. A digital detox day. The way people, in certain religious communities fast. 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.
Rebecca Berens MDYeah. Because I'm sure you have this experience too, I'm sure like we both are on call all the time.
Sonia Singh MDYeah.
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. But it's like, what if a patient calls
Sonia Singh MDme? I know. Yeah.
Rebecca Berens MDAnd that's even with something like this, I'm like, what if a patient calls me? I need to be available for the patient to get ahold of me. And that is one of the things that makes it so hard for me to not
Sonia Singh MDbe I'm sure a lot of parents would say that too. I feel that way about the gym when I go to the gym. A lot of other women, I will see them not take their phones. And I always take my phone because I'm like, I don't know, something could happen. What if my son's
Rebecca Berens MDschool called when I have
Sonia Singh MDschool? Sorry, I was at the gym. I just, I feel like there's a lot of fear with being completely disconnected.
Rebecca Berens MDYeah. And that's, it's so interesting 'cause even when we were kids, there was the home phone attached to the wall.
Sonia Singh MDYes.
Rebecca Berens MDAnd he was just like, anything could have happened to you. And who would know? And he would've just figured it out. And we probably would be fine. The patient thing is hard because that's a liability,
Sonia Singh MDyeah. That's true. It's a
Rebecca Berens MDjob expectation, it just, it's just, it's the expectation now. And that's part of the problem is you're expected to be available and be connected. And to be disconnected, it's seen as negligence.
Sonia Singh MDYeah.
Rebecca Berens MDAnd it would be probably prosecuted as negligence,
Sonia Singh MDright.
Rebecca Berens MDFor medical malpractice reasons
Sonia Singh MDfor us. Because that is the standard now,
Rebecca Berens MDright?
Sonia Singh MDYeah.
Rebecca Berens MDAnd 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. We have other safeguards in place to handle situations.
Sonia Singh MDSee, that sounds all good. And feeling,
Rebecca Berens MDI know it's not gonna happen,
Sonia Singh MDbut I one time my aunt came to pick me up at the airport without her cell phone and I was just so enraged. How could you? 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. And I was like, but I needed to be able to call you and know where you were. And even that I just could not handle it. So the idea of just not having, I don't know.
Rebecca Berens MDWhen I was in high school, so I was 16, my cousin was 18 and we went on a trip together to Spain, just us. There were none of our parents were with us. We went to Spain. We had a great time. Neither one of us had a cell phone. And I was talking about with this, with my mom recently, and she was like, I can't believe I let you do that.
Sonia Singh MDYes.
Rebecca Berens MDWhen I tell people that I did that in when I was 16, people are like, what? That's insane. And nowadays, people wouldn't even let their kids do that. Even if they would have a cell phone Yes. To be able to get in touch with them. And even in college, I, in summers, I would go home to Scotland and I would work. I worked at my dad's company in just doing some office work for them. And and I didn't have I had a cell phone, but it didn't work there. 'Cause it was before the time of your phone inter all over the world. Inter, yeah. And I just was out and about doing whatever, going wherever, no way of contacting anyone. And it was fine. And I think we also need to let go a little bit.
Sonia Singh MDYeah.
Rebecca Berens MDBut. That. Yeah, that's a pipe dream. 'cause I think it's just so culturally unacceptable to not be able to just be in contact with people all the time. Yeah. But there was a time when we did it and it wasn't that long ago. And I think it's important that we try to get back in a little bit.
Sonia Singh MDI 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. 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. Learn how to use these platforms in a healthier, more moderated way. And I think pushing back on a systemic level, with regulations that kind of limit the exposure of vulnerable parties like children.
Rebecca Berens MDYeah.
Sonia Singh MDTo some of these.
Rebecca Berens MDAnd because it is very clear that this is intentional.
Sonia Singh MDYes.
Rebecca Berens MDOn the part of the companies. Yes. Like a judge just found that, right?
Sonia Singh MDYes. Yes.
Rebecca Berens MDAnd it's not just my personal opinion, the judge also agreed with me. And and there's been numerous w whistleblowers about it. And I think that does need to be something that is taken very seriously and and I hope that now it will be. Yeah. But there's been this,
Sonia Singh MDyeah. I listened to I think the Daily or one of these podcasts had the CEO of YouTube, I might be using the wrong word. CEOI think it's the CEO of YouTube. But his argument was all of those features are there to enhance the user experience. 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. That is enriching their lives to the point that they want to keep using it beyond whatever other things they could be doing.
Rebecca Berens MDOh my God. Massive eyeball.
Sonia Singh MDI 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.
Rebecca Berens MDI think if that's the, if that's their argument, then let's make them opt in, not opt out. If those are additional features you can offer to make us. Value the use of the platform more.
Sonia Singh MDYeah.
Rebecca Berens MDLet us choose to do that. Yeah.
Sonia Singh MDDon't
Rebecca Berens MDmake that the default. 'cause even there's an app that nextdoor and I don't know if you, if I have, you're on the Nextdoor app. I hate it and
Sonia Singh MDI hate it too. I don't know how to turn off the notification.
Rebecca Berens MDSo exactly. Because I have actually multiple times gone in and unsubscribed from all emails and they keep adding new ones
Sonia Singh MDYes.
Rebecca Berens MDThat I have to go and unsubscribe to. Yes. They're doing it all the time. 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. And I'm like, just, I will decide if I want the new feature.
Sonia Singh MDYeah, 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. And I'm like, oh my God, what happened? But then I like have deleted the app and I forgot my password, so now I can't even read any of it. And then you
Rebecca Berens MDcan't, but you also can't turn off the notification.
Sonia Singh MDYes. So it's just filling up my inbox and making me anxious. Yeah.
Rebecca Berens MDDrives you crazy
Sonia Singh MDabout
Rebecca Berens MDburglaries. Do I unsubscribe from you and you just keep subscribing me to new list? It drives you crazy.
Sonia Singh MDYeah. Anyway, that's the story with social media addiction. I hope you feel better.
Rebecca Berens MDNo 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.
Sonia Singh MDYeah.
Rebecca Berens MDNot
Sonia Singh MDmake
Rebecca Berens MDthis so difficult.
Sonia Singh MDYeah, maybe the tides will turn. So anyway, if you want a full summary of our conversation today, you can find it on our substack. You can find that@theantisocialdoctors.com. 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. And the Substack Post also will include all of the references. There are a ton for this episode. 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. Okay, so thanks for joining us.
Rebecca Berens MDYeah, thanks Sonya.
Sonia Singh MDHey, guys. Last but not least, we have a very important disclaimer. This podcast is intended for educational and entertainment purposes only. 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. Listening to this podcast does not establish a physician-patient relationship between you and the hosts. We are doctors, but not your doctors. Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances. Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health. Medical conditions or treatment options, never disregard or delay medical advice because of something you've heard on this podcast. 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. Please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions. Medicine is not static and information may change over time. 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. Thanks again for joining us.