Managing social media for better teen mental health [PODCAST]

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Child psychiatrist Ellen K. Feldman discusses her article “How social media is shaping teen mental health and what we can do about it,” highlighting the growing concerns about social media’s impact on adolescents. She emphasizes the importance of monitoring social media usage, setting screen time limits, and teaching digital literacy to help young people protect themselves from harmful content. Ellen also stresses the value of in-person socialization to counteract social media’s isolating effects, especially for teens struggling with anxiety or depression. She offers actionable strategies for parents and clinicians to support teens in developing healthy digital habits and foster emotional resilience.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Ellen Feldman. She’s a child psychiatrist, and today’s KevinMD article is “How social media is shaping teen mental health and what we can do about it.” Ellen, welcome to the show.

Ellen K. Feldman: Thank you so much for having me here today.

Kevin Pho: All right, so just briefly tell us a little bit about yourself, and then move on to the article that you shared on KevinMD for those who didn’t get a chance to read it.

Ellen K. Feldman: So I am a child psychiatrist; actually, I practice general psychiatry out of North Dakota. We cover a pretty wide range there in terms of North Dakota and northwest Minnesota. And an interesting thing about me is the way I came to psychiatry was kind of a roundabout way, through an experience as a teen myself.

So as a somewhat rebellious teen, I was facing a summer at a summer camp where I had gone for years. I got in trouble. I was asked to leave, and having nothing else to do for the summer and being told I needed to find a job, I ended up working at a state psychiatric facility. And that really shaped a lot of my thinking about what I wanted to do for the rest of my life, which at that point was writing. So it probably gave me an experience of seeing, I don’t know, this is certainly not about the article itself, but it certainly gives me a lot of empathy for teenagers and the way they can turn their lives around and shape their lives through different experiences.

Kevin Pho: All right, inspiring story, of course. Now, you said that your background gave you insight into the article that you shared on KevinMD, “How social media is shaping teen mental health and what we can do about it.” So tell us about the article.

Ellen K. Feldman: I would say the article came about because I had noticed over the years, pre-pandemic I would say, that as I would work with kids, I was hearing more and more questions. My typical way of working with kids is I’ll have the parents and the kids together at first, ask the parents or guardians to leave, see the teen by themselves or the young child by themselves, depending on age, of course, and then bring the parents back in to answer any questions and present a plan.

And I started noticing that almost every session, when I would say, “And what questions do you have remaining?” they would say, “What do we do about social media?” or “What do we do about our kid who’s all the time in their room on their device?” And I realized at that point, A, I didn’t have time to answer that question at the end of the session. So I started putting that into my repertoire earlier on and discussing it. But I also realized I didn’t have a lot of answers.

And it occurred to me that parents were bringing up a problem that maybe hadn’t quite hit science yet, you know, or medical research yet. We were starting to have articles looking at this, but we hadn’t quite caught up to what parents were seeing, which is they really felt this is a problem and we’re not sure what to do about it. So I think that spurred my interest in how to look at, or what to look at, in terms of what the research tells us about social media and what we do for kids that are having difficulties in terms of reacting and responding and managing their time on social media.

And I’d say the other thing that probably spurred my interest is a lot of kids coming into our inpatient unit, and that includes young adults at a university, have a very hard time giving up their phones, as you might imagine, when they come in. That’s one of the most difficult scenarios, worse than saying goodbye to their parents often.

So the article starts out by looking at what we do know about social media and then what we can do, and really what we do know is limited by the research, and the research is a little bit behind because social media keeps evolving. Research that’s coming out now that maybe looked at Facebook is not quite up to TikTok. So it really is interesting, and it’s not quite up to the 24/7 access that a lot of kids have.

So it’s very interesting to think about what can we do, and one thing I talk about in the article is thinking about putting in controls and respect and safety measures early on, starting before your child has free access, to build in some sort of, it doesn’t have to be limits, but certainly some sort of management techniques that you both show them in action and are able to present to them.

Kevin Pho: So before we talk about some of the data, tell me about some of the stories that your parents are telling you about the effect social media has on their kids.

Ellen K. Feldman: Well, I don’t know if it’s fair to say that parents are telling me about the effect that social media has. I think what they’re talking about is they see their children withdrawing more and being on social media. Whether it’s in all different forms, if we’re right, there are many different forms of social media. So, in general, they see it as a divisive experience, not an inclusive experience, and it worries them, especially when you have a kid with mental health problems, because they’re not sure: Is this a healthy way that they’re getting support, or are they kind of hearing more things that are worrisome to them?

I had a very interesting group of parents who got together and actually ended up, with their kids, doing a kind of quasi-experiment. And they had social media dinners where just the family alone would say, “We’re not going to talk. We’re just going to communicate through text during this dinner, or through some sort of instant messenger, you know, some sort of immediate instant messenger account.” And afterward they used the time to say, “What do you think I was actually saying to you? What was my intention of this? Was I angry with you? Was I happy? And I’ll tell you what I heard from you.”

And actually, a lot of those kids thought it was great. They thought two things. One is that they learned some things, but they also thought their parents learned some things, and they thought it was a way that their parents reached out and said, “What do you like about this, and what do you not? What do we see as dangerous about this?”

Kevin Pho: It’s almost like meeting kids where they are, right?

Ellen K. Feldman: It kind of is. Yeah. I worked in a residential treatment facility for many years for teens. You know, they’d be there for months and months, no phones. And the kids were always asked to journal. That’s like a classic intervention. So the staff there developed a text journal technique where they would say to the kids, “If you can’t journal, let’s just text back and forth on paper.” And that seemed to work very well too for a lot of the kids.

Kevin Pho: Now, I see that there have been articles in the New York Times and other lay press about the connection between some behavioral health problems and social media, specifically anxiety. So tell us about what the data says in terms of the connection between behavioral health issues and social media exposure.

Ellen K. Feldman: It’s actually very interesting. There was a study that just came out the end of March from the University of South Florida, which looked at 1,500 kids, and they said, “We want to see. These are naturalistic studies. These are not controlled studies, right? Because we’re not taking away social media from people and comparing the two groups.” So these are naturalistic studies.

They said, “We have to start at age 11, because as we do the older groups, everybody has cell phones; like 95 percent of kids have cell phones. So we want to compare kids with and without.” So they start at ages 11 to 13, 1,500 or 1,300 kids, and they found that, surprise, having a cell phone didn’t lead to any problems. Owning the cell phone itself, controlled for socioeconomic status, etc., didn’t lead to any difference, and in fact, the kids with the cell phones maybe looked a little better in terms of mental health than the kids without. So that was a surprise for them.

However, they also found that more public posting on social media was associated with more anxiety and depressive symptoms in kids. That doesn’t mean a diagnosis of anxiety or diagnosis of depression, but those symptoms were more present. And very strongly in that study, any cyberbullying reported by the kids, even that, was strongly associated with decreased self-esteem, etc.

So it’s a very interesting study, but what they don’t know is, were the group of kids that didn’t have cell phones different than the group of kids that did? Was it the cell phone that made those kids more confident, didn’t have as many depressive symptoms, or was it that the kids that didn’t have cell phones, parents had noticed something and they were saying, “You’re not ready for a cell phone yet”? So we don’t know.

But that group is continuing a 25-year study now, and they’re expanding to 8,000 kids, and they’re going to be reporting, they said, every six months what they’re seeing. And all the studies that we’ve looked at so far, with the exception of very few small studies that I’ve seen, have been conducted in that manner. We don’t really have a control group where we can compare the benefits and risks, but we do see an association with more use of social media, especially public posting, with more depression and anxiety.

But then you also have to worry: Does that mean it’s less supervision? So are those kids that are posting more not being told, “Go outside. Let me see what you’re doing”? We just don’t know. But what I tell the parents I work with is, if you can build in something early on with your kids, whether it’s your own use of social media and how you’ve approached it, and really start at an early age showing them that you’re not totally invested in what other people are saying about you or liking your post, etc., you’re really building in safety techniques and a strategy that they can use going forward.

Kevin Pho: Now, whenever you see kids in your office for depression and anxiety, does the topic of social media come up, and if so, how is it broached in the exam room?

Ellen K. Feldman: Well, as I said, it used to be something always broached at the end, when I’d say, “What questions do you have?” And parents would always broach it. Now, I bring it up early on. And usually kids will roll their eyes and say, “I know all that. I know not to post. I know whatever I put online. We get all this information at the school.” But I certainly have kids who will come in and say, I’ve actually had someone yesterday who told me, “I just deleted my contacts because I just don’t have the bandwidth to withstand some of the interaction that I’m getting.”

So what I work with kids on is self-awareness. Really thinking about: What’s it giving you, and what’s it taking away from you? Is it giving you more satisfaction? Is it an anti-anxiety? For a lot of kids, it is. And is that as helpful as other things you can do? And that’s often where you have to have parents or guardians in the discussion, because, again, depending on the age of the kid, it’s not necessarily something that is well managed by a kid at certain ages. It depends on a lot of self-awareness, right? And kids want to feel better. We all do. And some people just don’t have the time to wait.

Kevin Pho: So you mentioned the best way is to really approach social media before the child is really exposed to it on an unlimited basis. So when you have these limits, what exactly are we talking about? Are we talking about supervised activity? Strict time limits? What are some examples of those limits that you talked about?

Ellen K. Feldman: I wish I could tell you science says X, Y, and Z. I go back to thinking about, and this is in my article, cars. When you take your kid out of the hospital, they’re in a car seat. And one of the reasons they are is that in the late ’70s, early ’80s, something around that time, a pediatrician in Tennessee said, “There are too many kids that are dying in car crashes. They need car seats.” And he and his wife helped advocate for the first car seat law in Tennessee. And that became a controlled study in some ways, because when they passed that law, they cut their deaths in half, and other states then followed suit.

So what I’m getting at is we can’t stay ahead of the technology, right? There were cars around well before the ’70s and ’80s, but it took until then, and maybe the ubiquitous nature of cars caught up and they were going faster.

Kevin Pho: Kind of sounds like the internet, right?

Ellen K. Feldman: Yeah. So at some point you have to say, “What can I do to prevent what appears to be potential harm?” I don’t know that you can say to a parent, “This is how much time your kid should be on.” But I think what you can say to your, because their school is going to be online for a lot of kids, right? Look what happened during the pandemic. But what you can say to your parents, and what you can say to kids, is be self-aware.

So how do you start out that way? You say, “Here’s the good.” You tell them, you show them from an early age. Kids are going to do more of what they will. Kids will learn more from what you do than what you say. So start out by showing what you want them to model, what you want them to see. If you’re finding yourself being on too much and they’re saying, “Mom, why don’t you turn off the phone?” you say, “You know what? You are right. I have noticed I’ve been on the phone too long today, and it’s not good for me.” And you turn it off and put it away, and even exaggerate that.

I guess a lot of it also depends on the kid themselves, right? Some kids respond better to words; some kids respond better to other interventions. But I don’t think you can give them, I’m not able to give, a “do this and do that.” And I’m certainly not an expert. I just know who I’m working with, and I’m reading the literature.

But I think that all the literature is very consistent in saying make sure kids understand the permanency of what they write, are able to critically examine the information that’s coming in, are able to understand the impact on themselves to some extent. Does it make me feel worse? Writing back a quick response that may make you feel better at that moment isn’t necessarily a good answer. And what are you missing when you’re on there? Those are probably the biggest things, and that posting probably needs to go into later years rather than earlier years.

Kevin Pho: Now, what about the cases where the child already has some behavioral health effects from being on social media a lot? You talked about that story that you saw, that child who was able to self-regulate and said he didn’t have the bandwidth and deleted all the social media contacts. But what about the child who has difficulty getting off social media and is exhibiting some behavioral health effect from that? How would you approach that scenario?

Ellen K. Feldman: Well, what I often tell parents, and tell kids, and I’ll do it even with video games, a lot of kids come in, say, “Can’t get off.” Parents will say, “I have a big blowout whenever we turn off the computer,” because they’re playing video games on the computer. If a kid can’t handle that, then you need to shrink the world a little bit. And the first thing they need to learn is emotional regulation.

You need to talk to kids: “These things may be, you know, your friends have it, etc. Maybe it’s age-appropriate, but for you right now, we’re going to focus on learning self-control. Once you learn self-control, we can go to the next step.” And you reintroduce it gradually.

Kevin Pho: One of the things you also mentioned in your article was how in-person socialization can sometimes mitigate the negative effects of social media. So talk more about that connection.

Ellen K. Feldman: I’m not sure exactly what part of that article you were pointing to, but I think it’s really like most things in our life: We need balance, right? So I don’t know if you can say it will mitigate the effects, but certainly, it’s interesting, back to that South Florida study, what they noticed about the kids that were doing well that had the cell phones is they were getting together with friends more in person than the kids that didn’t have the cell phones.

Now, did that have anything to do with their mental health? It’s hard to know. All of these are associations, not causations. But we do think that there are different skills, and I think we all know, intuitively, you know that by our own experiences, there are different skills involved in talking with someone face to face, in interacting with someone on a personal level, than on a screen. So kids need both.

Can you actually, I don’t know if it’s fair to say you can mitigate the effects of social media, because we’re not sure, again, if it’s an effect of social media or if it’s an association with social media. Maybe social media is a proxy for something else. So we don’t really know.

But we do know that, just like, I don’t know what’s good, I wanted to say candy, but I don’t know what’s fair, “candy is good for you.” But candy is not necessarily good for you. It’s OK in small pieces. Maybe you could say exercise. Exercise is good for you, right? But it doesn’t mean that it can’t be too much for you. And how do you determine when it gets to that point? How do you determine when, “You know what? I need other things”? There may be different forms of exercise, different forms of socialization.

And kids’ brains need to develop in multiple ways. It’s the other thing. The difference, one of the differences when we’re thinking about kids and adults, is the developing brain. We want to make sure it gets full development, right?

Kevin Pho: One of the things I often hear is that parents often don’t know what to do. And I think that this podcast is very helpful in terms of giving that advice. They have this technology, social media. How much responsibility is on the social media companies themselves for how addictive their products are and the connection their products often have with behavioral health issues? How much responsibility should these social media companies themselves take on?

Ellen K. Feldman: That’s a very tough question. You know, maybe it’s akin to, well, we could go back to cars and requirements for seat belts, airbags. We can go back. We can look at movies, right? Ratings of movies. I don’t know that I could give you a “how much should they.” Yes, of course they should. If they’re doing the studies and if they’re aware of how addictive they are, they absolutely should build something in. But I think we shouldn’t wait for that.

I think part of being a physician and seeing patients is also thinking about what can help prevent some of the things I see. And again, we don’t know that social media is causing anything in terms of mental health problems. We know there’s an association. So why not think about what we can do and what parents can do, and let the industry catch up and hope that it does catch up. Maybe the industry needs to hear from parents: “You want my kid on this. I want to see the right controls.” Or from kids.

Kevin Pho: We’re talking to Ellen Feldman. She’s a child psychiatrist. Today’s KevinMD article is “How social media is shaping teen mental health and what we can do about it.” Ellen, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Ellen K. Feldman: Well, I would say exactly what I just said: Let’s learn from patients, learn from patient experiences, listen to your patients, and it’s OK to generalize and say, “I’m seeing a trend. What can I do about it? What should I do about it? How can I draw this into something that I use in my practice every day or that I help other patients with?” And I’d say to parents, have the courage and be empowered to control what you could to shape the way you want social media to be used in your household and for your kids, with the hope that maybe they will continue it as they grow and become more independent.

Kevin Pho: Ellen, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Ellen K. Feldman: All right, Kevin, thank you very much for having me.

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