Mind Dive Episode 66 transcript - The Digital Dilemma: Teen Depression and Social Media with Dr. Meredith Gansner

The following is a transcript of Mind Dive episode 66 and reflects the conversational style of the discussion in its entirety. Edits have been made for clarity while preserving the original wordings and context of the speakers.  

 

Dr. Bob Boland Host

 

00:02

Welcome to the Mind Dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, dr Bob Bowen and Dr Kerry Horrell.

 

Dr. Kerry Horrell  Host

 

00:11

Monthly we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.

 

Dr. Bob Boland Host

 

We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far.

 

Dr. Kerry Horrell Host

 

So thanks for joining us.

 

Dr. Bob Boland Host

 

00:26

Let's dive in. I'll say yet again I'm like really excited today.

 

Dr. Kerry Horrell Host

00:35

We're always excited for our guests.

 

Dr. Bob Boland Host

00:37

I know, but I've been really hopeful to get this one on. This is Dr Meredith Gansner. She's an attending child psychiatrist at Boston Children's Hospital and instructor of psychiatry at Harvard Medical School. Her award-winning research focuses on problematic digital media use in adolescents with existing psychiatric illness, relationship between high-risk substance use and digital media use, and the use of smartphone-based digital phenotyping and other longitudinal digital technologies to assess and manage digital media habits. She wrote a book recently, really written for, fair to say, the general public, though it's great for clinicians too. Teen Depression Gone Viral, which is about depression and the effect of digital technologies, social media and all that.

 

01:28

I recommend the book I read it gave me a bit of PTSD because I raised kids at the beginning of this all and I remember all the fights and stuff and I probably wish I'd read your book before. Of course you've had to have written it when you're probably about I don't know what age, but anyway. But all the same, welcome very much. Thank you for being on, Dr. Gansner.

 

Dr. Meredith Gansner Guest

 

01:50

Thank you so much for having me here.

 

Dr. Kerry Horrell Host

 

01:54

I work with the adolescents and the young adults here at Menninger and like, yeah, reading this, I don't I didn't have a similar reaction like cause, I don't have children yet, but I was like Whoa, this is happening. This is so relevant to the current population of young people who particularly have psychiatric illness. The use of digital media is complicated and I'm a big believer, just to say this on the front end, that we don't throw all of it out. I don't think social media is completely and utterly bad. I'm a big believer, just to say this on the front end, that we don't throw all of it out. Right, like, I don't think. Like social media is completely and utterly bad. Like I think there's things, especially in the wake of COVID, but it is problematic and it needs to be thought about carefully.

 

Dr. Bob Boland Host

 

02:32

So gosh, I'm excited, right. So, that being said, that being said, yeah. So tell us about your career, though you know, in digital media. How can it influence youth with psychiatric vulnerabilities?

 

Dr. Meredith Gansner Guest

02:52

Yeah, so it's been 13 years almost 13 years, I guess since I realized this was an area of interest for me personally. So I was in med school at the time and I did a child psychiatry rotation and we had an emergency services part of it where we would see kids in the emergency room that came in because they were thought to potentially be endangered as well for others, and it was clear that again 13 years ago, we were starting to see this twirling in of kids who may have had their laptop taken from them or were getting into stuff online like meeting up with strangers and nobody knew about it.

 

03:24

And I remember thinking like meeting up with strangers and nobody knew about it, and I remember thinking like this is not, this is not great, like this just seems like something we should be putting more effort into looking at, especially among these kids who are already pretty vulnerable. So at the time I did a chart review of a bunch I guess at that point probably thousands of charts looking at digital media related chief complaints or presentations. We did see a significant increase over time, over four years, of the charts that we looked at and I guess ever since that point I was like you know, this is really, this isn't going away. Like in that four years, right, like there was an increase and certainly since the time that we did that study, things have only gotten more confusing. And also I think it's really beneficial in a way, right Like you're totally right, Kerry, that there are tons of benefits to social media, but it's just, it's complicated.

 

04:13

And so I guess, as a clinician, I thought, well, we need to do something to help protect our patients, and they're the ones who are going to be really feeling the brunt of all the ills of social media and their parents.

 

04:26

So I wanted to start looking into research in that population specifically, and I will say that over the last 10 years or so, I'm increasingly grateful that I did, because these same issues that we've been studying in the general population related to social media like does social media cause depression?

 

Right, we're still trying to figure that out, right? Those studies are still being done, and it's this very divided, I guess hotly contested issue where people are absolutely sure and other people are absolutely like no, no, there's no way. And so it's just gotten in the way of us being able to and I might want to say we I mean mental health clinicians to really access and help the kids who are most vulnerable. And so I guess, especially during COVID, when I was doing inpatient work and we had this influx of kids coming in who were now online all the time and getting into lots of trouble, I realized that there was just nothing out there for parents to really have some sort of concrete, tangible information about how to even understand all the things that could be at risk for their child, but also the good that is out there for kids with depression or anxiety online. So that's kind of where this book came from.

 

Is wanting to try to provide something in the way of concrete help for these families, Because right now I still don't think that research is doing enough to translate that into meaningful clinical interventions.

 

Dr. Kerry Horrell  Host

 

05:53

And I will say for clinicians too, because I mean, you know, over the last year, at the different conferences I've been at, there has been a massive topic people want to know more about as people treating young people, which is what do we recommend? How do we think about this? Like it does feel like the jury's still out. I will say, before we hop into that, I did want to kind of come back to you. You focus in your book on depression specifically. Um, and it's it's very clear that getting into this book you get a nice primer on, like what is depression and why is particularly important to look out for in young people. And I wonder if you want to say anything about why you focus on depression particularly and if, like, our young people these days are more vulnerable to depression compared to previous generations, and if that's, yeah, like why specifically depression as a focus?

 

Dr. Meredith Gansner Guest

 

06:44

Yeah, that's a great question. I mean, certainly rates of depression in youth are rising and have been rising even before COVID. I say in the book, and I still believe this now. I think that reasons for that are somewhat complex. We are doing a better job screening for depression. There's universal screening now, recommended for teens, and primary care visits. I think there is maybe some progress being made in destigmatizing depression and mental illness so that people might be more willing to be evaluated and admit that they have depression and get diagnosed, but I also do wonder if rates could be rising due to numerous other factors that we haven't quite yet elucidated.

 

07:22

There are some people that suggest kind of widening disparities between economic groups or like socioeconomic status in countries and disparities related to systemic racism in developed countries. Those seem to be the countries that are really struggling the most with rising rate of depression. So certainly depression just seemed to be the most pressing illness I think to talk about.

 

07:43

But in addition to that, I think depression is an illness that is really kind of uniquely vulnerable to almost all of the problematic ways that you can engage with social media. And I mean, I'm fully willing to backtrack on this if research is done and I am absolutely wrong. But that being said, from the preliminary research that I've done in our emergency room, we've looked at presentations again related to digital media.

 

Mood disorders are far and away most likely to be associated with problematic digital media use and if you think about it like just, there's so many ways a depressed being can look to social media for help. Right, either to distract themselves with symptoms, so they're just online all the time to get this kind of immediate boost of feeling better about themselves. It's not the theme right If people are liking what they're saying or even just getting emotional connections to others. And then, concerningly right, there are kids that go online to understand what it means to be depressed and also what it means to have suicidal thoughts. And that gets particularly high risk when kids are turning to sources of information that definitely are not screened in any way to make sure that they follow the AFSC standards in terms of talking about suicide in a way that doesn't inadvertently reinforce suicidal behavior. So I thought it was probably the most pressing topic to discuss and also relevant to the digital media.

 

Dr. Bob Boland Host

 

09:09

Well, that makes sense.

 

Dr. Kerry Horrell  Host

09:13

 

One thought I'm having to is, I imagine, both on the research level and the clinical kind of practical on- the- ground level, this is impossible because of the very quick changing landscape of social media. There are new apps and some stick and some don't stick. And again, I'm thinking on a research level, if you're like we're going to make this protocol or this plan, you have to list out which apps are we going to follow or what are we going to look at. That app might not even be relevant by the time we're collecting data.

 

09:42

But then, even on a practical level, with families working with teens, I think one of the biggest struggles that I've seen with families is that the kids make these compelling points that if families get more involved in restricting social media use or even just being involved in it, that they're going to feel the kids saying I'm going to feel worse if I can't be connected like the rest of my friends are on Snapchat.

 

10:03

If I can't be involved in those conversations, I'm missing out with peer engagement. That's going to make me feel worse and I think that's what I see families coming to me with. As they say hey, well, as my kid's therapist, is it better if I limit their Snapchat use? Or they're saying it's making them worse, and so I think that's a big question on my mind is like, how do parents distinguish? Like this is normal, this is kind of like gonna help them right now, or this is kind of the trend and this is actually contributing or playing a role in or exacerbating symptoms of depression? Because, again, I think youth are compelling. I think they're incredibly good at making the argument for why they need to be unmonitored and unrestricted in their access on the internet.

 

Dr. Meredith Gansner Guest

 

10:47

Yeah, no, you've been very convincing always from a very early age. To your point about the research, absolutely it's been. I mean, from, I guess, the personal level. It's impossible to study to the level of detail that we would need to get to prove any sort of causal relationship. Right, it's just it moves too fast and even just knowing in the moment how a person's response could relate to an exposure, it's just too tricky. You'd have to be watching them on video all the time and no kid is going to allow that. No IRB is going to consent to that study.

 

So academic research in this field has been just really like snail's pace. It just is sluggishly progressing. Maybe, but because of that, really no good evidence-based clinical intervention have been studied or brought forward to then implement and to kind of practice universally. So that's been tricky. And the people that do have the data are the companies or private companies in general, and some of those companies may have good intentions, but if they are private companies selling a digital media product then inherently they're never going to be interested in whether or not we should be restricting access to digital media right Because they rely on people using using it.

 

Dr. Bob Boland Host

 

They don't get to do that.

 

Dr. Meredith Gansner Guest

 

12:04

So that is pretty tricky. And also, you get into some really very ethically gray areas when you are proposing to look at some pretty high-risk stuff that kids are doing online, you know, do you just watch and wait to see what happens. Right, that's a pretty terrifying prospect. So, yes, research is I don't have good words for it it's moving very slow.

 

Dr. Kerry Horrell  Host

 

12:29

Yeah, I'm thinking even of last year, the amount of new apps that came and went that I heard people be like are you on Lockit? My nieces and nephews, who are now all preteens, are like get this app. And I'm like no, I don't need another app for this.

 

Dr. Meredith Gansner Guest

 

12:48

But, yeah, it sounds impossible and you can't keep track of it. So then that relates to your next point about what to do, and I think parents' instinctive reaction is usually to just ban it or worse, to ban a specific app. But again, if they do that, a new app is going to pop up again anyway. And I think the thing that has been most reassuring is that the same high-risk content that started on MySpace generations ago it's coming up now on TikTok, right. Yeah, exactly, the internet is kind of, unfortunately, drawn to the same high-risk content and the same issues are true, and so I think if we can do a better job with well, I think, with our educators and clinicians, and teaching them how to talk to families about the psychoeducation surrounding digital media use, how it can make it far for someone who is struggling with depression or anxiety, to both turn to factors that we know help with things like depression, like exercise, good sleep habits, you know, vitamin D, all these things that we are like okay, we're pretty sure this is helpful for kids who are depressed.

 

13:54

Social media, unfortunately, takes that away. Digital media takes that away but also helping them understand how, yes, it can be helpful for them, but maybe when individuals are in a particular state of psychiatrically distressed, there are going to be parts of that social media use, particularly that will be detrimental to them or more detrimental to them. Right, it's not like one person can use these technologies, another person can't. It's that just depending on where you're at and where you are emotionally, they can be more problematic, and so I try to help parents understand that that's really more of the issue is working with your child to have a conversation about what time should they be using social media platforms with no supervision. What time should they maybe get more supervision? Or maybe not use even a specific app at a specific time of day? Right, there's just, there's a lot more. There's a lot of heterogeneity in, like, how you can use social media.

 

14:50

Right, it doesn't have to be no social media use at all or, like all the time, unlimited access to everything 24-7, right, there's so many different ways parents can work with teens to help find something that works for them in terms of safety and getting the team on board with that, and that you're not planning to take it away because you understand what it helps them with, then that will also help free other coping skills that don't involve screens. That maybe could address some of those things they were trying to turn to social media for right, like connection with other people.

 

Dr. Bob Boland Host

 

15:16

I mean the problem with it in one, one of the many problems, I think, is that you know it is like, as you point out, ubiquitous behavior.

 

I mean everyone uses social media, literally everyone, so even though I know the research is limited, what's your sense of how a parent or anyone else can tell if the behavior's problematic and it might be increasing vulnerability to depression or anxiety or something else?
 

Dr. Meredith Gansner Guest

 

Yeah, it’s good that you asked that question because parents often have that exact same question. To which I give the probably maddening answer of : If your child is depressed, you need to assume that problematic digital media use may be lurking somewhere in the background. or the risk at least is highly elevated. And so I don't know that it necessarily always works. In the converse, because certainly individuals can have problematic Internet use behaviors that don't necessarily have depression itself associated with, maybe a different condition, but certainly like it's a red flag. But when your child is depressed, I think you parents are automatically consider that social media platforms would be a place where they encounter some high-risk content or maybe more prone to becoming dependent on their youth to try to regulate their mood, and so trying to take a more proactive approach as soon as that diagnosis is made, so that you're not waiting to see whether or not your child does develop problematic youth, and then that'll also ideally help you think more about how you can optimize again those lifestyle changes that we know can be helpful for kids with depression. Maybe it won't treat depression, but at least can help them move faster to recovery with things like medication and therapy.

 

Dr. Kerry Horrell  Host

 

I'm going to some experience with our young adult unit especially. I don't think I've seen the same on our adolescent unit, but with our young adults. For as long as I've been there, this has been shifting, actually in the last year, but for most time that I've been working on that unit, they don't get any access to their phones while they're there and while many of them come in being like that's not great, or I feel mad about that, or we feel frustrated by that. A week or two in, I think so many of them have said look, this has been helpful, Not being on Instagram and not being on TikTok and not being on Snapchat.

 

Now, granted, of course, many of them are concerned about the social ramifications of it, but they're like wow, I feel better and it feels similar to when I've actually had a couple of patients recently, and I love these moments where they're like this is so dumb, but when I go for these little mental health walks that you suggest, it really does make me feel better and and I'm like I know, isn't that just wild that these little things do help. But I wonder if that's part of what both young people and parents need to hear and understand, is that it clearly sometimes these apps can increase or amplify certain things like isolation, and I wonder if you can tell us a little bit about, in the research we do have in the work you've done, what have you seen with what does like? How does social media amplify or increase certain things that could be related to depression and how might we address that?

 

Dr. Meredith Gansner Guest

 

18:19

Yeah, it's funny, I also had those experiences when I was doing inpatient work and it was great. It was so great, not even prompted, just saying wow, I haven't had my phone for X amount of time and I don't know that it was really helping me all that much. Because if the team comes to that conclusion on their own, that is so powerful. That's so much more powerful than us saying you should probably cut back on your screen time. That is so powerful. Yeah, it was so rewarding, I loved that.

 

But I think, in terms of your question of isolation, I think you know social media platforms. Kids start out going on them right as a way to connect with others when they're not depressed and you know to share, you know memes or just share social situations to get news right, just to engage with other Gen Alpha and Gen Zers. And I think that then behavior starts to, I think, become harder to separate from at first. When kids go on these platforms and they realize that you know they may be feeling more tired, feeling more tired when they're depressed, less energy, less motivated, they may feel as though the pressures of trying to do academic work are too hard. It's when the surrounding normal benefits of disengaging with digital media become less or feel harder to get to or less easy to access than social media specifically but I think you know the internet, video games, anything becomes just an easier tool to use to get those benefits Right.

 

You start feeling like, okay, well, I'm distracted from how I'm feeling, I don't have to really work to try to, you know, connect with friends outside. I don't have to like, struggle through academics and you just start to. It's avoidance. Right, there's lots of. There is good research looking at avoidance and problematic internet use is highly informative. Right, we have a pretty enough evidence at this point connecting the two to say like people who have problematic internet use are usually avoiding and that's, you know, escaping right, um, and that that also they do feel better, right, like it doesn't give this initial burst of like I feel better or this makes me feel good.

 

I mean, one of the studies we did a few years ago. We actually saw that, while the teens that we followed who had more severe symptoms of anxiety and depression have more feelings of dependency on their internet use, overall when you look at it cross-sectionally, right, but moment to moment they actually had improved anxiety once they had these kind of more intensive engagements with the internet. It seemed to actually maybe increase their, their, not their mood, because that actually didn't seem to change, but their anxiety actually significantly did. Um, when they were experiencing like this, some increased dependency and the internet and excessive use, um, and so we well, you know, maybe this is right because they're using it as a coping skill and and a lot of, a lot of researchers have said that is likely the case and like this is a coping skill and I'm sure, very anecdotally on inpatient units, like kids, all the time, like, like we know that you know that then furthers the feeling of isolation and that like they just have themselves off from the world.

 

Because it is their coping skill, it's easier. The parents don't want them to separate from it because they're saying it's my coping skill and so they don't know what to do because they feel like if they take it away they're terrible parents and then that just furthers their kind of falling into this isolated behavior. Then you have the concept of FOMO, right, fear of missing out that if your friends are hanging out without you, then that feels even harder and worse, and so that can potentially further your depression.

 

So then maybe you just don't even want to try to hang out with your friends or go online. You can just bring about all sorts of other factors that just make it easier to stay on the internet, and so you can't kind of break out of that pattern of behavior and then unfortunately, sometimes it's going to lead to school refusal, and then parents are in way over their heads and the teens that just want to stay on their phones the whole day.

 

So it's a really. I guess you use a very cliche term, but it's a slippery slope.

 

Dr. Bob Boland Host

 

Yes, yeah. So it's always like a surprising, at least to me early on, about the isolation part, because you know, I mean, social media is supposed to end isolation, so it sounds like we're eternally connected with everyone.

 

Dr. Meredith Gansner Guest

 

22:41

I took that point. Sorry to interrupt.

 

Dr. Bob Boland Host

 

22:43

No, that's not all I had to say about it.

 

Dr. Meredith Gansner Guest

 

22:46

But I think like it's also really important right now that this last year people have been talking more and more about fans of social media. I think, especially in the current turmoil that our country is in in many respects, that marginalized youth are, I think, one of the populations, and that usually is LGBT kids and kids who are racial ethnic minorities in their geographic locations. Right, like those kids, there are studies showing really significant benefits for them connecting to other people like them. Dr Brindisha Tynes does some fantastic work on online discrimination and their lab does a study looking at racial ethnic identification and how, if you're actively involved online on social media related to that identity formation, then actually that's beneficial. So for certain populations of youth, it may be really really helpful for them to connect to others and to get over like this kind of in-person isolation that they may have in their real-life communities. So I think that is important to note.

 

There are teens for whom the sense of isolation they feel in their geographic locales may be overcome by social media communities. But again, it really depends on the balance of the two right and making sure at least, if they are going to be using those platforms in that way, that they're still getting out of the house and going on walks and trying to connect with others.

 

Dr. Kerry Horrell  Host

 

24:05

One barrier I could imagine is getting teens to buy in, because this is what happens. This is simplified, but this is what commonly happens in my experience. Parents are worried, they want to do what's best for their kid, they want their kid to feel better, and so they start setting these boundaries, saying, hey, we are going to turn off your phone by nine or turn in phones, we're going to. You know, there's all sorts of apps that keep track and then kind of shut down apps after a certain amount of time on them or make them unavailable during, like school hours, and I I mean, I think, for weeks after stuff like that gets implemented.

 

What we're talking about in therapy me and the kid is their anger towards their parents, the vitriolic feeling of being oppressed, and it's different, you know it's different than they're feeling depressed. They now feel just angry and then activated. But I think that's one of the things that's tough and I know, you know, in many cases that does tend to subside, but that's, I think, just just, and I know I've already alluded to this or asked about it, but that is just such a tough piece. And I think this is where I see parents crack. They make it three weeks and then they're like no man, this is not going well for us and I don't know if this is a hyperbolic analogy, but it feels similar to if a kid was like yeah, when I use weed it helps me to feel better. This is how I'm getting by, and parents like being like we just can't stand by you doing this thing, that we know excessive use of this is not going to be good for you. But it feels like with social media again, compared to something maybe a little more objective, like drugs or alcohol or like risky behaviors.

 

That's where, like, I just see parents go down this line of like, okay, we tried, but they just got worse and so angry and moody, and like it just didn't seem worth it. It didn't seem worth it to actually implement these changes and expect that the kids would implement it or that they are going to, I think, have the motivation to be like yeah, you're right, mom and dad, this, these, these apps that I'm on actually make me feel kind of sad. So I'm gonna. It's like I don't think we're. I can't imagine most kids fall into that camp. So, again, a very impossible question to ask.

 

Dr. Bob Boland Host

 

26:11

But who better? 

 

Dr. Kerry Horrell  Host

 

26:13

But who better..and why not just see what you think about it? What are some of the practical strategies that parents and teens can adopt to set these boundaries without it making them so frustrated or there being that resentment that is there?

 

Dr. Meredith Gansner Guest

 

26:27

Yeah, I mean, I don't know. Well, to the last question first. Uh, I don't know that there is always going to be a way to do it without the teen getting angry yes um, there are increasing.

 

Yeah, like I think that that or really being like slightly perturbed, at least having some sort of negative emotion from it there are increasingly, uh, clinicians and educators who are really pushing for just way more emphasis on digital literacy. Not just like knowing how to use devices right like my my eight-year-old is pretty good at using devices at this point but like knowing the kind of, um, mechanistic techniques that, like, these platforms use to get you to just keep watching, because your teams also don't like to feel like people are trying to play them and so, if we did a better job earlier on, and being like, yeah, just you know, like these, these companies are doing to just get your money and they are making billions of dollars off of teenagers.

 

We know this. So it's uh, it's a technique that, again, it's not going to solve, but at least if a team already knows that kind of going into a depressive episode it might be easier to start getting buy-in, but I have no, there's no research evidence that looks at that in a very systematic way, so I can't swear to that.

 

But my other controversial kind of “how do we tackle this and get buy-in approach” and I say controversial not to the teen, teen, but actually to the family, the parents, I really think that it should be a family, family approach to limiting technology use. Now that we have all these studies connecting problematic digital use and parents who now their kids actually having higher rates of depression interesting again, like many confounding variables, right, because these parents are also going to be more likely to have depression and other psychiatric issues too. But yeah, we know that they're not unrelated and we also know, developmentally we get our coping skills and learning those from our family, our parents, our important parental figures, right. And so if you're seeing your parents get home from work and just like oh, and just get on their phone and just that's what they do, kids are going to be like oh, yeah, well, that's, that's how I solve it.

 

Dr. Bob Boland Host

 

Right Like you.

 

Dr. Meredith Gansner Guest

 

28:41

Just that's what you do. You say, oh, I'm exhausted, like oh, or like I had a really hard day. I just need to look at my phone. Right, I've done that. My husband has definitely done that, and so it's something that we all now do if we have digital technology. But I think parents need to recognize how that has probably influenced their kids from an early age and then, when their kids do start eating something skills and it can be like, hey, this is a pretty easy way to just relax and not thinking more, can be like, hey, this is a pretty easy way to just relax and not thinking more. Um, parents don't understand, like, don't realize that you know proactively, they probably need to work on building other coping skills with their kids that don't involve screens. So she, if she ever finds this recording years from now, she'll probably hurt me for this. But basically, my kids.

 

I really work with my nine-year-olds on developing coping skills that don't involve screens and having like she has a little coping skills box with all these two little digits and thinking about you know all the tools she has in her real literal toolbox and you know metaphorical toolbox she can use when she has gone past, maybe, her allotted screen time for the day, but it's still really having a rough day and wants some kind of outlet. But again, like that's not something that we necessarily do a good enough job helping parents realize what should happen with their children or needs to happen with their kids. So I think parents getting on board with okay, if we're going to make you do this, we should do it too and we should cut back our use or actively. It's so cruel to be like, okay, I'm going to sit here on my phone or be on my laptop, even working or tuning out, and be like, no, I'm sorry you can't go on this because you're depressed, like that's just horrible.

 

Dr. Bob Boland Host

30:12

Yeah.

 

Dr. Meredith Gansner Guest

 

30:13

So I think if parents can also do what they can to make it look like this is a family movement that we're doing to try and encourage healthier behaviors and to support you in this, even if the teen is protesting, it's harder to fight Right, it's harder to say like okay, well, if everyone's trying to hold to these rules and like maybe I can't put up such a thing about it because they are doing this to support me, I think that's probably one a good way to get by, and or a better way to get by than just unilaterally being like that, like sorry you're cut off.

 

Dr. Kerry Horrell  Host

 

That's a great.

 

Dr. Bob Boland Host

 

30:41

I love that well, so now just your. What you're saying before about drinking or pot or anything else, is that you? If you're going to curb their behavior, you probably should start with yourself.

 

Dr. Kerry Horrell Host

 

30:50

Yeah, oh, yeah, right yeah, I think I think a big part of it is is working as a whole family on boundary setting, and what that is going to look like and just being consistent I mean, like I think that's that's where I think clinicians can continue to come in is is recommending family therapy, recommending parent coaching like I think a lot of families so understandably need help with this of how do we do this well, consistently and in a way that's going to be sustainable. And to me, social media use falls right into other risk behaviors that people think about using parent coaching for, so it makes sense that it's a family system level approach.

 

Dr. Meredith Gansner Guest

 

31:25

Yeah for sure.

 

31:27

I think the dream would be that.

 

31:30

My dream would be that we maybe stop funding so much these studies that are really determined to try and figure out whether social media makes you know kids like globally depressed and starts looking specifically at how we can design these earlier interventions and like public health strategies to tackle this problem, because right now we are just putting band-aids on things and there are a lot of people out there that have some really great ideas about how to manage digital media use and they ideally should be having their strategies that they've developed, or even some protocols that they've developed like tested in a meaningful way and implemented.

 

32:08

We can say this works. And then there's some people who have just taken advantage of the situation and are really kind of designing techniques that will have no long lasting effect and we are basically just saying, okay, like you know that this problem exists, if you do like a quick internet search, right. Like you have no idea that what's recommended is going to actually be helpful. We have really very especially in this country, we have very limited research on any sort of meaningful clinical interventions in terms of like involving, you know, full systems work and public health prevention. I think we could turn a lot more to countries outside of the Western hemisphere for that right, like they have been tackling this issue in multiple levels for years now and far more effectively than we have in this country, but sadly there isn't as much cross-talk.

 

Dr. Bob Boland Host

 

32:56

Well, along those lines are there particular misconceptions here. You've heard that we really should be tackling or correcting in parents about like what interventions are useful or which ones are not.

 

Dr. Meredith Gansner Guest

 

33:07

I don't know if correcting as much as just letting parents know that what's out there hasn't been tested, and so it's probably a good idea if they don't throw a bunch of money into, like a fancy parental control app subscription that we don't actually know to what extent it will work in a longitudinal way. I won't say that those kinds of apps have no benefit, especially in really high-res teams. They certainly do, and in my book I didn't say that explicitly. There are times when this may be something that can have to happen, but there is a price for that. I don't mean a literal price, right, but there's also a developmental, I guess a relationship cost as well. Right, like you're supposed to, with your teen work on helping them navigate the world in safe ways and become an adult that is confident that they maybe know how to navigate the world in safe ways.

 

34:07

And if your approach is to just have this tracker on them and they're like well, you can't access this, or a lot of access to this, or it flags every time they look at something, right, like there's going to be a loss of a discussion or a meaningful way that the kid can learn to interact with those platforms which they might encounter when they're like 18 and have their own phone, right, but you've lost that opportunity to talk to them about it Because you've just been like, nope, you can't look at that.

 

34:33

Or maybe you're like I saw you looking at that. That can happen again. Or the kid knows you're looking at it and so they go find that content somewhere else and they don't talk to you about it because they know they're not supposed to look at it. So I again I don't want to say that there isn't an opportunity for those, but I do think that we really need to be careful that we're not societally kind of deluding ourselves into thinking that those are the answer to the problem, because I think that there's just too much at stake in terms of actually being able to help raise digitally smart children and using these technologies for an easier fix in a way, and then using these technologies for it's an easier fix in a way and it helps, and in parents are like you think about how the media addresses this topic, which is a whole other problem. Sorry for the soapbox right, but like it's. You know digital technology is like or social media is like killing children right, like it's so wild.

 

35:21

It's wild. And so parents like myself, right, these, you know, millennial gen extra parents are like, oh my gosh, my kid, like of course they're going to be anxious, like I think they're actually the anxious generation. They're the ones that are like, oh my goodness, like I can't parent, right, like all these things, they're going to attack my kid online like sexortion, like cyberbullying, and so it's easy then to say, okay, I need to buy an app. My, okay, I need to buy an app because my child's depressed or they've been looking at suicide content online and that is, I think, then, really, really hard for them to turn away from once they've started using, if they're that anxious and so they're going to want to keep that subscription and keep watching the kids. But if you can't do that as a parent, you have to let it go at some point.

 

36:02

And you have to teach your kids how to use these things right.

 

Dr. Kerry Horrell Host

 

36:10

It reminds me a bit of the research. My research has been in gender and religion, so I've looked specifically at things like um abstinence-only sex education, for example. The research on that is very clear. Abstinence-only sex education is not super effective.

 

36:20

Uh, in regard to I'm sure yeah, I know, shocking, especially for young people, uh, and in fact you see higher, you see higher risky sexual behaviors and higher risks of teen pregnancies with that kind of education, compared especially to safe sex education. And I feel like that again, with anything risky, it feels like to neglect the idea of helping people do something safely for the sake of abstinence, or just like that's too much. I mean especially, I think, growing up religious, I saw this a lot Parenting strategies of we're shutting it down, just nothing, and then the minute the kid can get away with it they go overboard with it. So I'm with you. I think that like having a safe like and then having open lines of communication, like that feels that feels so important.

 

Dr. Meredith Gansner Guest

 

37:11

But it's so weird, right? Because like we let them learn to drive like we have a whole course of driver's education at school.

 

You help them through that process, then they have to take lessons on driving in most states, I think, as I did and you have, to like us somebody teach you how to drive and then you have to take a test to prove that you're not terrible at least not so terrible that you're a danger to other people. Right, like it blows my mind that we're okay with that doing like safe driving, but yet like safe any other which driving can be incredibly high risk, but yet like we're fine. You know the note like the sex like I'm doing no drugs and DARE works real well, like it has been proven time again it doesn't work with high-risk behavior.

 

Dr. Bob Boland, Host

 

Yeah, as we begin to wrap up for today, I wonder Dr. Gansner I wonder if you have any final words reflections for the clinicians listening on on how to be thinking well about this, approaching this with families ?

 

Dr. Meredith Gansner Guest

 

38:02

yeah, I think I mean this is more for parents, but I think, as clinicians, it's one of the most helpful things that we can do for our parents is just letting them know this is more for parents, but I think, as clinicians, it's one of the most helpful things that we can do for parents is just letting them know that this is really hard and that their inability to navigate this issue and helping their depressed child or their child with depression use social media and digital media in a responsible way, like that, isn't easy and that we unfortunately have not been able to, I think, help parents enough and they are feelings of inadequacy, and they're bewildered and they have no idea what to do and there's terror at having their child scream at them or break their child because they take away their phone. Those are all so understandable. You know as clinicians, we're here to help them through that process, and that you know these things can be done. Kids can stop using their phone excessively, right, they can use them in responsible ways. But I do think that there's a lot of like parental blame and frustration and all of this just because they don't know what to do. I mean we can't lie and say like, yeah, we absolutely have answers because we don't but at least we know that we can help them through it.

 

Dr. Kerry Horrell  Host

 

39:15

And we know that you know, they love their kids and they're just fine, there is help out there and a great place to start is with Dr Meredith Gansner's book teen depression gone viral as a resource. And again, thank you so much for for talking with us.

 

Dr. Bob Boland  Host

 

39:27

Yes, thanks so much.

 

Dr. Kerry Horrell  Host

 

39:28

It's great to see you and to talk with you I don't think we mentioned this on air, but, but you you two knew each other from your training days.

 

Dr. Bob Boland Host

39:37

Former resident yeah, famous psychiatrist.

 

Dr. Meredith Gansner Guest

 

39:39

That's not exactly true, but thank you. No, actually about you. He gave my graduation fee that my residency program, the sweetness.

 

Dr. Kerry Horrell  Host

 

39:49

Thank you again for being here. Dr Gansner, Again you've been listening to the Mind Dive podcast. I'm one of your hosts, Dr Keri Harrell.

 

Dr. Bob Boland Host

 

39:56

I'm Dr Bob Boland.

 

Dr. Kerry Horrell Host

 

39:58

Thanks for diving in. The Mind Dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

 

Dr. Bob BolandHost

 

40:10

For more episodes like this, visit wwwmenningerclinicorg.

 

Dr. Kerry Horrell Host

 

To submit a topic for discussion. Send us an email at podcast at menningeredu.