While true that teens are all about their social life, the proliferation of social media platforms accessed through smartphones has introduced some valid concerns. The impact of social media on teen mental health is just beginning to garner attention from the scientific community, and the data is a cause for concern.

Rates of depression and anxiety, eating disorders, self-harm, and suicidal ideation are rising at alarming rates among the teen cohort. While it is too early to make a definitive causal correlation between the heavy use of social media and these mental health conditions, it isn't difficult to notice how the increasing rates of distress coincide with the increasing use of social media among teens.

Parents of millennials remember how back in the early 2000s they teens were introduced to IMing and MySpace, and they were worried about those. Those old social platforms offered just a tiny glimpse into what would unfold for generation Z. Now Gen Z, or today's teens and young adults, have a smorgasbord of about 15 popular social media platforms to engage with. In fact, today's teens spend 5-8 hours daily on social media, based on a recent poll of over 9,200 teen respondents.

How Social Media Impacts the Teen Brain

It is important to understand that the brain is still experiencing significant development during the teen years. The teen brain is more vulnerable to addictive substances, including social media use. A recent study demonstrates how the teen's brain reward system shows the same type of dopamine release in response to "likes" on a social media post as one might have to a substance of use. The study also points out that the teen experiences "withdrawal" symptoms when they are not permitted to engage on social media anymore, similar to when a drug of abuse is withheld or unavailable.

Social media platforms are designed to be addicting. The developers understand the brain's reward mechanism and behavioral conditioning. The goal of the app is to monetize the platform, so the more time they can keep the user on board, the more ads will get click-through. The design is geared to keep the individual coming back for more, to constantly seek approval and affirmations.

The brain imprints this affect in its reward system, setting up a desire to repeat the positive experience. This reward response wiring keeps the teen returning to their social media accounts dozens, if not hundreds of times per day. Teens become obsessed with curating a perfect online persona and clever, engaging posts, and then constantly check to see how their profile is being received by followers. This obsession with self-image and acceptance can lead to mental health challenges.

Mental Health Conditions Associated With Excessive Social Media Use

Most parents are unaware of the copious use of social media their teens engage in. It may come as a shock to learn that a teen might spend 4, 5, 6 or more hours every day glued to their phones or tablets while on social media. The effects of excessive social media use are only recently being studied, but many negative effects have already surfaced. These might include:

• Decline in academic performance, due to distraction and time wasted that should be used for studies
• Loneliness and isolation, due to a decline in face-to-face interactions
• Neglecting daily responsibilities in favor of being on social media
• Poor sleep quality or insufficient sleep, due to continuing to be on social media during the night
• Becoming physically unfit, due to a reduction of physical exercise and activity
• Becoming obsessed with social media
• Fear of missing out (FOMO) keeps teens constantly checking their social media
• Being persuaded to spend excessive amounts of money on beauty products and fashion
• Experiencing fallout, such as shaming, from posting provocative images on social media
• Loss of interest in activities or extracurricular hobbies in favor of social media
• Becoming envious or jealous of people they follow on social media
• Teenager with low self esteem, due to feeling inferior to those they follow on social media
• Signs of mental distress, such as experiencing:

• Depression. Teen depression includes feelings of sadness or despair, change in appetite and eating habits, sleep problems, decreased interest in the hobbies or activities usually enjoyed, fatigue, difficulty concentrating or making decisions, negative view of self, and suicidal thoughts. Depression could be brought on by cyber-bullying or social media shaming.

• Anxiety. The most common teen anxiety disorders include generalized anxiety disorder, social anxiety, and panic disorder. The symptoms include excessive worry, dread, or fear, irritability, racing heart, shortness of breath, sweating, and avoidance behaviors. Anxiety may be stoked due to a feeling that the teen does not measure up to peers.

• Body dysmorphia. Body dysmorphia involves the irrational and distorted views of one's physical appearance and hyperfocused attention on perceived flaws. Symptoms include obsession with body image, excessive use of laxatives or diuretics, or an eating disorder. Teens may develop body dysmorphia as a result of viewing filter-perfected beauty images on social media and feeling badly about themselves in comparison.

Is There Anything Positive About Social Media?

When considering all the potential negative effects of social media on teen mental health and wellness it may be difficult to accept that there might be some positive aspects to using social media platforms. For teens whose parents impose and enforce daily limits on social media use it can be an adjunctive avenue for socializing and sharing. Social media should not be replacing real life social events, but just complementing the usual in-person socializing.

Also, social media can assist teens who suffer from social anxiety or extreme shyness to reach out and socialize in what there perceive to be a safe venue. The social media platforms offer a way to connect socially without the fear of being judged in front of a group at a school event, for instance.

Some teens may access social media to garner support for a mental health issue. They may join a few groups who share a common problem, such as anxiety, and share their experiences without the fear of stigma while benefiting from a source of social support.

Mental Health Treatment for Teens

When a teen exhibits signs of emotional distress due to excessive social media use it is important to open up the lines of communication that much more. Sit down with your teen and check in with them. Ask them if they are feeling upset about anything specific and might want to talk. Sometimes the teen will appreciate the opening a parent can provide, especially if the parent approaches the teen without an agenda. Just note that you are concerned about them and try to get them to open up.

Teens are often reticent about being transparent with their parents, especially when it involves social issues. If the teen continues to display signs of distress, it is time to have them evaluated by a medical practitioner. A doctor will conduct a physical exam to determine if there is a medical explanation for the symptoms. If there is no health condition present, the teen will likely be referred for counseling.

A psychotherapist can conduct both individual and family therapy sessions to assist the teen in exploring the core issues that may be contributing to their depression or anxiety. The therapist can help them identify negative self-talk or irrational fears, and then guide them toward adopting new thought patterns that are affirming and positive.

When Residential Treatment is the Appropriate Level of Care

A certain number of teens that struggle with a mental health disorder may be better served through a residential mental health treatment program. These programs are designed specifically for teens, including family-focused therapy, relevant experiential therapeutic activities, and highly customized treatment plans. Just getting away from the social media and other situations that are triggering the distress can provide a chance for the teen to focus on learning new coping skills.

Teen residential treatment programs provide the following elements:

• Psychotherapy. Evidence-based psychotherapy helps to engage the teen in a discussion that may reveal an underlying psychological issue or past traumas that may be contributing to the emotional distress. There are different modalities a therapist can choose from, depending on the teen's specific diagnosis. These might include cognitive behavioral therapy, psychodynamic therapy, solutions-focused therapy, dialectical behavioral therapy, exposure therapy, and mindfulness-based cognitive therapy.

• Group therapy. Group therapy sessions involve small groups with other teens and a therapist who facilitates the topics of discussion. The group participants are encouraged to share about their emotional struggles, self-image issues, family problems, and fears while offering each other support in the healing process. These group sessions can foster peer support and bonding while in residential treatment.

• Family-focused therapy. The family is the teen's primary source of support. When there is dysfunction, conflict, codependency, abuse, neglect, or other sources of family tension it can impede the teen's recovery. Family group sessions provide opportunities to examine the family dynamic and to teach more effective communication skills and conflict resolution techniques, as well as foster healthy boundaries to improve family functioning overall.

• Holistic and experiential therapy. These complementary activities are effective in keeping the teen engaged in treatment while also providing opportunities for gaining new transformative insights.

Teen social media use is now intrinsically embedded in the childhood experience. When monitored and limited, social media can be a harmless adjunctive route for socializing. However, due to the addictive properties built into the social media design, these platforms may expose teens to sources of emotional distress.

About the Author

Dr. Arastou Aminzadeh is a triple board certified physician in psychiatry, child and adolescent psychiatry, and addiction medicine, and is the co-founder of BNI Treatment Centers in Agoura Hills, California. Dr. Aminzadeh is a fellow of the American Society of Addiction Medicine and also a fellow of the American Psychiatric Association. A well respected leader in the field, he also holds an adjunct faculty position at the University of Southern California, Keck School of Medicine, where he completed his residency and fellowship.