Over the past month, I have seen a surge of patients presenting with anxiety and/or depression in my practice. “I am so scared, scared to go out, scared to be home alone, scared of how I am going to pay my bills, and scared that my family members and friends could die in the next few weeks. I don’t know what to do,” said one patient recently.
Although this particular patient was feeling it all, everyone has probably experienced some variation of at least one of these thoughts over the past few weeks. In the context of what is going on right now with COVID-19, we call this situational anxiety and/or depression and expect most of it will dissipate once the pandemic passes. However, as we don’t know how long that is going to be, it is especially important to educate and empower patients with knowledge about how stress can affect their long-term health and what they can do about it.
To put it simply, stress increases the number of inflammatory markers in our bloodstream which, in turn, decrease our immunity, making us more susceptible to infections, and putting us at higher risk of developing chronic disease states such as autoimmune conditions, dementia, diabetes and heart disease, to mention a few.
One of the most powerful things someone experiencing these thoughts can contemplate is how much their worry will change the outcome of that which they are worried about. In most cases, the answer is not at all.
I love to adapt the concept of Steven Covey’s Circle of Influence from his book The 7 Habits of Highly Effective People. I ask the patient to draw a circle about the size of a plum and then draw a circle around that about the size of a big salad plate. The small circle represents their circle of influence and in this area, they are to write the things they can change or influence by worrying about them. The space outside of the small circle and inside the big circle is where they write all the things they worry about that their worry can’t change. This is a powerful visual exercise to help patients see there is very little they can control or change by worrying about it. This realization has helped many patients create a positive thought habit when they find themselves feeling overwhelmed with worry, and in turn, make a conscious decision to not worry.
In addition to decreasing the time spent as a “worrywart,” there are a few essential lifestyle habits that also help with anxiety and depression such as getting seven to nine hours of quality sleep, 15- to 30-minutes of daily exercise and eating a rainbow of fresh whole foods. But there is something more you can do, and it is very powerful. If you are my patient, you will not leave the office without learning about it…
Meditation. Not only has this practice shown to directly decrease symptoms of anxiety and depression, but it also has been shown in studies to reduce blood levels of inflammatory markers.
The best part is that it is very simple to incorporate. I recommend downloading a meditation app (there are many free ones) and starting a practice of meditating 5-minutes twice a day. Over time, you slowly work up to 15 to 30-minutes twice a day, usually upon wakening and before bed.
Another fact that surprises patients is that for mild to moderate depression and anxiety, walking briskly for 30 minutes was found to be just as effective as commonly prescribed medications. So, adding a brisk walk and getting outside, whether it’s in your yard or your neighborhood, also can help with the feelings of overwhelm.
Of course, some patients need anti-anxiolytic and antidepressant prescription medications and that is absolutely fine. Adding these other holistic modalities is not going to detract from the benefits of medication and will most likely work in synergy to produce a stronger sense of overall well-being.
Most of us don’t remember a time without digital technology. Cell phones, laptops, and tablets are a part of most households today. These devices have made it easier to connect with friends and family, keep up with current events, take care of financial matters, and research unlimited information.
Some of the ways that digital devices have integrated themselves into our culture in a positive way are:
Digital technology allows you to stay connected with friends and family. Apps allow users to connect through text, video, audio, and sharing media. In the digital world, anyone can find someone to talk to through online communities which helps people feel connected to other individuals.
Digital devices have revolutionized entertainment. People are having fun online playing games, watching videos and using social networks. Television media has also evolved with services like Netflix and Hulu which allow you to watch shows online from your phone, laptop or tablet anywhere you happen to be.
Banking and Finance
Technology has made banking and finance much easier as well. You can deposit money, transfer money and pay bills from your phone, computer or tablet without leaving home. Investing is fast and easy by connecting your bank account to an online broker. Through banking apps, you can even send someone money directly to their bank account with low or no cost.
The Negative Side of Digital Technology
Although technology has made our lives easier, there is also a downside to tech. We have become dependent on our devices and they often take over our lives. There are side effects of using digital devices continuously.
Research is discovering that digital technology is affecting both psychological and physical health. The largest group experiencing the most problems are children and teens.
Distraction from digital devices has become an ever-growing problem. American youth are using cell phones in the classroom as well as at home. Attention is divided between class lectures, checking texts and social media.
A study done by the Academy of Pediatrics found that American youth spent about 7.5 hours a day taking in media and toggling between multiple streams (Uncapher, et al., 2017).
Researchers at Cal State Dominguez Hills are looking deeper into the compulsive use of tech devices and what happens with students who have constant notifications on their phones. Dr. Rosen, one of the researchers at the college believes that kids feel they can do several things at once, which he refers to as Media Multitaksers (MMT) (Berdik, 2018).
Although teens feel they can do several things at once, your brain can realistically only pay attention to one thing at a time so other information such as class lessons are being ignored by the brain in favor of notifications on the phone.
Research is finding that kids who spend a great deal of time multitasking on their devices exhibit poor memory, impulsive behavior, and do poorly at school (Uncapher, et al., 2017). This phenomenon occurs in children and young adults whose minds are still developing.
MMT is not limited to the U.S. but happens globally. Research is still trying to pinpoint if the media multitasking is causing cognitive issues in youth or are youth with cognitive issues more prone to multitasking.
With the increase of children using digital devices researchers are also noticing that children who spend a lot of time with digital devices are having problems with socializing.
Studies are suggesting that although computers are beneficial for academic and cognitive skills, they harm social and psychological development (Hosokawa & Katsura, 2018).
A Japanese study found that in Japan the use of mobile devices increased from 15% to 48% when kids reached junior high level (Hosokawa & Katsura, 2018).
With teens and young adults spending so much time on mobile devices, researchers are noticing a trend between digital device usage and loneliness because teens and young adults are not having face to face interaction with their friends.
In a 2015 study, Chinese researchers found that college students who were addicted to their phones were lonelier and did not socialize (Bian & Leung, 2014). On the flip side, those who reported loneliness and shyness seemed to be more addicted to their phone.
A Korean study published in 2017 found a relationship between smartphone addiction and attachment anxiety, loneliness, and depression (Kim, Cho, & Kim, 2017).
Mounting evidence is showing an association between excessive use of mobile devices and social isolation and mental health problems in children and young adults. Too much screen time is being associated with poor grades, behavior problems, anxiety, and depression.
Psychological issues are not the only problem being noted with too much screen time. People that excessively use digital devices are also experiencing multiple health problems.
Using computers, tablets and cellphones can lead to digital eye strain. The average adult worker spends 7.5 looking at the computer screen (American Optometric Association, 2020). Adults are noticing more:
Neck and shoulder pain
Experts recommend taking breaks while working on the computer by looking away from the screen for a few minutes.
Because most people look down at their smartphones, smartphone addiction may contribute to neck and back pain due to holding the head forward in an unnatural position when looking at their phones or tablets. A small study found a clear association between smartphone addiction and neck problems (AlAbdulwahab, Kachanathu, & AlMotairi, 2017).
Another documented link to having too much screen time is obesity. Researchers attribute this to several factors.
The consumption of high calorie, low nutrient foods and beverages while using digital devices
Less time sleeping
Low activity level
Childhood obesity is becoming an epidemic, and time spent on digital devices has been solidly linked to obesity. Several studies done over some time looked at outcomes of reduced screen time both with and without diet and activity changes. They found direct links between less screen time and weight. Less time spent on digital devices decreased weight in children compared to the control groups (Robinson et al., 2017).
Blue Light Effect
The body naturally releases melatonin to signal that it’s time to go to sleep. Electronic devices emit a blue light that can suppress the release of melatonin, causing you not to be sleepy. The blue light tricks the body into thinking it’s still daytime. You feel alert instead of sleepy. This happens a lot with teens, however it can also affect adults and children who are addicted to their devices.
The more time you spend on your phone, tablet, or computer in the evening with social media, answering texts, or watching videos the longer it takes for their body to release melatonin. This causes challenges with falling and staying asleep. As a result, you don’t get enough sleep which can lead to symptoms of depression and contribute to their overall mood.
Overall the excessive use of digital devices is interfering with cognitive development in children, contributing to obesity and contributing to poor mental health.
Unplugging for Technology
Digital devices can have positive outcomes if you use them moderately along with a healthy lifestyle. This means balancing your time between your devices and physical, social and family activities. How then can we unplug from our devices to have that balance?
Detoxing from your digital devices may be difficult at first. Here are some tips for beginning your journey to having a more balanced lifestyle.
One Hour Rule
Set aside one hour day and turn off all your devices. If this seems impossible, you can start with 15 minutes and work your way up to an hour. The world will not come to an end if you don’t answer someone’s text, email or phone call. You can even make this a family tradition by turning off phones during dinner and having conversations.
Have a Device-Free Zone
Choose one room in your home that you don’t take your devices. This could be the bedrooms or living room, but no cell phones, tablets or computers allowed. Make a habit of putting devices somewhere before you walk into that area. The device-free zone because a relaxation area with no distractions.
Replace the Device Habit
Instead of checking social media or other media on your phone first thing in the morning or before you go to bed, find something else to take its place. You can read a book, meditate, do yoga, exercise, or write in a journal. These things replace the device checking with a positive habit that’s good for your physical or mental health.
For teens detoxing from digital devices may be a challenge. Here are some tips to help them detox.
Establish rules about screen time like how much time and where they can use their phone or computer
Encourage your teen to be social and have face to face interactions
Balance their screen time with activities
Educate your teen about media
Keep Screens Out of the Bedroom
Digital devices are consuming our lives. We use them on a daily. Although technology enhances our lives in many ways, it also has negative influences as well. Children, teens, and young adults are especially vulnerable to mental and physical health issues due to excessive use of digital devices. By unplugging and detoxing from our devices, we can live a healthier lifestyle that allows for more fulfilling activities and time with family.
AlAbdulwahab, S. S., Kachanathu, S. J., & AlMotairi, M. S. (2017). Smartphone use addiction can cause neck disability. Musculoskeletal Care.
American Optometric Association. (2020). Computer Vision Syndrome. Retrieved from American Optometric Association: https://www.aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndrome
Berdik, C. (2018, January 22). Dealing with digital distraction. Retrieved from The Hechinger Report: https://hechingerreport.org/dealing-digital-distraction/
Bian, M., & Leung, L. (2014). Linking Loneliness, Shyness, Smartphone Addiction Symptoms, and Patterns of Smartphone Use to Social Capital. Social Science Computer Review.
Hosokawa, R., & Katsura, T. (2018, July 25). Association between mobile technology use and child adjustment in early elementary school age. Retrieved from PLOS|ONE: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199959
Kim, E., Cho, I., & Kim, E. (2017, June). Structural Equation Model of Smartphone Addiction Based on Adult Attachment Theory: Mediating Effects of Loneliness and Depression. Asian Nursing Research, pp. 92-97.
Robinson, Thomas & Banda, Jorge & Hale, Lauren & Lu, Amy & Fleming-Milici, Frances & Calvert, Sandra & Wartella, Ellen. (2017). Screen Media Exposure and Obesity in Children and Adolescents. Pediatrics. 140. S97-S101. 10.1542/peds.2016-1758K.
Uncapher, M., Lin, L., Rosen, L., Kirkorian, H., Baron, N., Bailey, K., . . . Wagner, A. (2017, November). Media Multitasking and Cognitive, Psychological, Neural, and Learning Difference. Retrieved from American Academy of Pediatrics: https://pediatrics.aappublications.org/content/140/Supplement_2/S62