Many of us–myself included–often find ourselves spending more time on our smartphones than we intend to. One recent survey showed that 57% of Americans feel addicted to their smartphones. Another survey finds that millennials and gen z feel the most addicted.
Earlier this year, Dr. Vivek Murthy, the U.S. Surgeon General, called for a warning label on social media platforms in a New York Times guest essay. He pointed to a retrospective cohort study (Riehm et al, 2019) showing that adolescents who self-reported more than three hours a day on social media experienced double the rate of anxiety and depression symptoms. He then highlighted surveys showing that teens spent an average of 4.8 hours a day on social media and that roughly half said social media worsens their body image. He called the current mental health crisis an emergency, worsened by social media, which necessitates broad and swift action, despite imperfect evidence.
As I’ve been on sick call, and therefore more tethered to my phone than normal, I’ve noticed that my screen time has increased. In light of this and Dr. Murthy’s recommendation, I wanted this post to touch on technology and wellness: screen time and mental health. To make it directly related to our wellness, I’ll focus on studies of adults.
We all know that there are uses of smartphones (and more broadly screen time in general) that help us flourish: apps that help us learn languages, podcasts to teach us new skills while we’re on the go, our peers teach us new things daily in the Sinai Education WhatsApp, question banks that help us study for the boards, mindfulness meditation apps, etc. The potential uses of smartphones to facilitate and improve our education, wellness, knowledge, and skills are both endless and subjective.
But their excess is referred to as maladaptive mobile phone use or problematic smartphone use when it negatively interferes with our lives and causes distress. Addiction manifests as tolerance, withdrawal symptoms, and dependence, accompanied by social problems and distress. It doesn’t just apply to psychotropic substances, but also as behavioral addiction to technology, including the internet, video games, and of course, smart phones.
A systematic review by Ratan et al., 2021 looked at smartphone addiction and associated health outcomes in adults. It included 27 studies and sample sizes ranged from 30 to 5,372. Seven studies were in South Korea, four in China, Turkey (4), Saudi Arabia (3), international (3), and India, USA, Italy, Thailand each had one. All studies were cross-sectional and included various scales, with the Smartphone Addiction Scale (SAS) being the most common. All studies found associations between smartphone addiction and mental health and/or physical health problems. 14 of these studies focused on mental health, all showed an association with mental health pathology–primarily depression and anxiety. Some studies also associate smartphone addiction with musculoskeletal problems, poor sleep quality, and neurological problems. Although it’s a systematic review, it consisted of exclusively observational, cross-sectional studies, with a high degree of heterogeneity and is overall low-quality evidence.
Another systematic review (Santos et al., 2024) looked at the association between screen time and mental health in adults. It included 32 studies with a total of 77,219 adults (eight studies with 54,814 people from China alone), as well as six studies from the US, two from Australia, and all of the following with one study: Finland, Taiwan, Canada, Bangladesh, Brazil, Netherlands, UAE, Iran, Japan, UK, Mexico, and one international. Of the studies, 22 were cross-sectional, seven were longitudinal, and three were RCTs. There were no overlapping studies from Ratan et al. (the previous systematic review). 22 of the 25 studies that investigated depression found depression positively associated with screen time. This was true of 13 of the 19 studies for anxiety, and 5 of 9 studies for stress. This is an even more heterogeneous group of studies than the previous, with mostly observational data, although it includes three RCTs.
Looking into the 3 RCTs included in this systematic review:
- Hunt et al., 2018 showed less loneliness, depressive symptoms, and FOMO when social media in the experimental group was limited to 10 mins per day (via monitoring app – Screen Time) vs their normal social media use in the control group. N=143. 76% female. Adults, but age not specified. USA. Small effect size.
- Lambert et al., 2022 showed improved well-being, and reduced symptoms of depression and anxiety in the experimental group that stopped using social media for one week (via monitoring app – Screen Time and with strategies to avoid social media) vs normal use (control). N=154. 62% female. Average age: 29.6. UK. Moderate effect size.
- Vally et al., 2019 showed results that conflict with the above two RCTs. This RCT showed lower levels of subjective well-being, higher degree of negative affect, and increased loneliness in the experimental group that abstained from social media (instructed to delete all social media apps). N=68. 53% female. Average age: 22.1. UAE. Medium effect size.
- I find it surprising that it showed the opposite of the other two RCTs. But it notably does have a much smaller sample size and a different population than the other studies (higher % of males; and UAE vs USA and UK).
- I suspect how we detach from social media matters. The two RCTs that showed benefits with decreasing social media use were monitored via the Screen Time app. And Lambert et al. additionally provided tips regardings how to stay off social media. These included signing out of social media sites, deleting these apps, turning their phone off, turning off social media notifications, disconnecting from wifi, and downloading an app blocker that blocks relevant social media sites, but none of them were compulsory. Whereas in Vally et al., those in the experimental conditional were simply asked to delete social media apps.
Lambert et al. provided the experimental group with strategies to reduce their social media use, with subsequent impressive improvements in mental health. There are many online blogs with strategies to reduce your screen time. Some of these interventions have evidence to support them.
A multimethod study, which included a systematic review, evaluated the effectiveness of apps to reduce mobile phone use (Rahmillah et al., 2023). Out of 1,238 apps identified, 55 met inclusion criteria and 13 of these apps had studies which examined their efficacy. Evidence for these 13 apps was found in 19 studies. Although five of them had a combination of different designs, they were primarily: five RCTs, four experimental designs, six cross-sectional designs, one longitudinal study, and one interview series, and an observational research-secondary data. Apps found to be effective in reducing phone use were Screen Time, Forest, and AntiSocial. Various strategies were also effective in reducing cell phone use, including grayscale mode, app limit features, and mixed interventions (combining apps). Combining these three apps reduced mobile phone use–AntiSocial, Headspace (mindfulness), and Pacifica (mood tracking). A combination of 10 nudge interventions decreased both mobile phone use and maladaptive mobile phone use. These nudge interventions were: disable notifications, keep mobile phone on silent and out of reach, disable easy unlocking and use a password instead, enable sleep mode, enable grayscale mode, hide social media apps, use computers instead, verbalize taking a break from phone, leave phone at home, and minimize its use.
Informed with these data, we can make our own strategies to maximize the benefits of our screen time use, while minimizing its overuse and maladaptive use.
This is my current strategy to use my iPhone in a way that aligns with these goals. It’s a combination of tools I’ve used in the past, and some new ones I’ve picked up from this review.
- Grayscale is the default on my phone most of the time, I’ve setup a shortcut to allow switching back to color easily
- I take it off grayscale at work, while studying, and with tasks that are hindered by grayscale
- I use Screen Time (IOS) to track my app use
- I also set a 15 minute time limit (that can be extended) for social media apps
- One Sec is an app that forces a 10 second pause and brief reflection prior to opening designated time-wasting apps
- I also put time-wasting apps further away from the home screen, requiring more effort to access them
- I will also briefly delete certain social media apps, if I feel that I’m overusing them
- I use Freedom (app), which is more aggressive with app blocking when I need to focus or when my smartphone use feels higher than I’d like
- Cell phones stay out of my bedroom while I’m sleeping (unless I’m on sick call). I have other alarms set up in my bedroom
- With my phone in another room, I read a chapter of a paper book (if time permits) before bed
- Notifications are turned off for all social media sites, and with other apps where this is practical
- I’ll periodically re-evaluate this and consider adding or switching out various apps and strategies
Try some of these strategies and see which ones work for you!
Yours in intentional use of screen time,
Danny
