Scott Webb (Host): Over the years, the CDC and many other health organizations have raised concerns about excessive screen time and its impact on physical and mental health. Joining us today is Dr. Dimitrios Tsatiris, a Psychiatrist with Summa Health Behavioral Health Institute and Clinical Assistant Professor of Psychiatry at Northeast Ohio Medical University. He'll discuss mental health outcomes related to screen time and healthy ways to manage screen time to promote mental well-being.  

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

Doctor, it's nice to have you here today. I was telling you that I have a little bit of a maybe more vested interest in this topic than some other topics that I've hosted for Summa Health, simply because I have a 17-year-old. She loves her phone. She's always on her phone. She's always looking at her phone.

And screen time, I think, is something that's particularly relevant to parents, but humans, adults, kids, everybody. So let's start there. Let's define screen time and what kinds of activities are typically included under that term.

Dimitrios Tsatiris, MD: Well Scott, I appreciate the invitation and I empathize with you. I've got a six-year-old and an eight-year-old, and that's something that we also have to take care of at our own home as well. Screen time, it refers to the amount of time that we spend using electronic devices with screens.

It can include smartphones, computers, TVs, tablets. And it can include a number of activities such as watching videos, playing games, or just simply browsing the internet.

Host: Yeah. And I remember Doctor, as a kid, you know, we had like one TV in our house, right? And it was like maybe 19 inches, one TV. And I remember being yelled at by my mom sort of saying, hey, don't be too close to the TV. Don't watch TV too much. It's bad for your eyes. It's bad for your brain, whatever. And I think about now how many TVs and screens, and we just spend our days, right, Doctor. Like just always looking at something. I'm looking at a computer right now. Presumably you are as well. So I guess it makes me wonder, when we think about the, maybe the mental health concerns, the significant ones, are there some that are associated with excessive screen time?

Dimitrios Tsatiris, MD: Yeah. No, absolutely. And what's interesting is how we have tablets and access to screen times in every room of our houses. Right. And that excessive screen time is associated with a number of negative effects. The first one is lower psychological well-being. Studies have shown that children, teenagers, and adults who spend more screen time they tend to have higher rates of depression and anxiety.

Another, potential negative effect is the fact that it can affect our sleep, right? We've all been there. You know, we're on our phones or our tablets late at night. And, you know, you end up staying up later than expected, and then it's kind of hard to turn the mind off, right? So it can affect our sleep negatively.

It's also worth noting that it can impact our attention span negatively. It's also not good for relationships. I think we've all seen this where, you know, we go out to like a restaurant for dinner and we see at a table where two people are on their phones instead of talking and connecting with each other.

Right? So, uh, these screens can actually take us away from our loved ones and they can have a negative effect on our relationships. And then finally, they're not good for physical health, because many times people who are on their screens, they experience a lot of stress and stress is not just mental. It's also physical. So an increase in stress is associated with negative physical effects.

So what I would say is that, you know, sitting down, watching, spending too much screen time is also not good for not just our mental health, but also our physical health.

Host: Yeah, mental, physical, I can totally picture what you're saying where you look around at a restaurant and everyone's looking at their phones. My daughter does that. She, you know, hangs out with friends, but all they really do is sit at Starbucks and play on their phones. You know, and maybe occasionally look up and occasionally laugh at something or whatever.

And, you know, I think especially with teens, but not just teens, but especially it's something that I'm concerned about with a 17-year-old; anxiety, depression, stress. Things like that. Is the research finding that too much screen time is perhaps at least one of the underlying causes of those things? 

Dimitrios Tsatiris, MD: Yeah, it really is. There have been a number of studies amongst children, amongst teenagers and amongst adults showing that increased screen time is associated with lower psychological well-being. And there have been studies amongst adults, for example, it was published in the Nature Journal and the intervention was, hey, let's cut back your screen time to three hours per week.

And they found that that reduction in screen time, it improved well-being and mood in adults, within a two week timeframe. So what we're seeing here is that screen time comes at a cost to our mental health and I think we all need to be working on finding ways to be more mindful when it comes to using these devices.

Host: Yeah. And as I said earlier, it's not just the teens, it's the adults too. It's the parents too. And you know, one of the things that my daughter's high school has done, Doctor, is they basically, collect the phones now at the beginning of class. And presumably that's to help them, you know, pay attention better, better memory, problem solving skills, those kinds of things.

I'm not sure how it's working out, you know, I get conflicting reports from our daughter, but I'm wondering in general when we think about prolonged screen time and the cognitive functioning, what's the connection there?

Dimitrios Tsatiris, MD: Yeah, and I think it's a very reasonable intervention what they're doing at her school. So yeah, I mean, excess screen time is associated with reduced attention span. So for example, when we're spending too much time in front of a screen, what's happening is we're overloading the brain with sensory stimuli.

So eventually the brain gets tired, right from the system overload, which makes it harder for us to focus and concentrate on a task at hand, right? It's hard to pay attention to what somebody is saying when you are staring at a screen at the same time. But the other thing that's happening is that it lowers our attention spans because whenever we're like in, in front of a screen and we get bored, what do we do?

We just shift our attention to the next thing, the next website, the next app, the next YouTube video, right? So what we're doing is we're having a hard time enduring boredom, you know, and then what we're doing is we're really just shifting our attention span rapidly from one stimulus to the next. So as a result, we're actually constricting our attention spans, but being in front of a screen.

Host: Yeah, and I think that so many of us, Doctor, think that we're multitasking because we've got the TV on, maybe we have our laptop on our laps, we have our phone in our hand, and we think that we're multitasking, you know, in other words, doing all these things simultaneously, but as you're saying, we're, what we're really doing is just switching from one thing to the next thing, and oftentimes we're doing it out of boredom, right? Yeah.

Dimitrios Tsatiris, MD: Yeah, no, I agree. That multitasking, it's really an illusion. You know what, I tell people one thing at a time, slow down, be present, and just focus on one thing, one task at a time.

Host: Yeah, for sure. You know, I think, Doctor, one of the ironies of social media is it was supposed to be this thing. It started out to be this thing that kind of brought people together. You know, radio made the world smaller. Television made the world smaller. The internet was supposed to bring us all together.

But it feels like Doctor, that sometimes it actually is the other way. It's sort of counterintuitive that this great social thing that's supposed to bring us together, actually for some, fosters more loneliness and isolation. Maybe you can talk us through that.

Dimitrios Tsatiris, MD: Yeah, totally. I look at social media for example, as a tool, as a knife. You know, you can do some really good things with a knife, like cut a steak and enjoy it, or you can chop your finger off, right? So we have to be very mindful and intentional when using social media. And the problem with social media is that people present a facade of their lives, right?

They present the highlights of their life. So what happens is as human beings, we engage in social comparisons. We use others as a measuring stick, as a metric, and we compare our real messy lives to someone's projection of their idealized life. And that's a comparison that, you know, doesn't make us feel good about ourselves.

Now, back in the day, before social media, before the internet, you know, we would engage in social comparisons, but just with people in our vicinity, right? The person in the neighborhood, the person at school. But now what happens, is that you engage in an entire stream of social comparisons with a scroll of a finger.

So we've taken these social comparisons, we've increased their frequency exponentially, and we've also made them a lot more intense, because you're comparing your life with someone's presentation of their life, and I think it's coming at a tremendous cost to our mental health.

Scott Webb: Yeah. It is so interesting. You know, I have friends quote unquote on say Facebook Doctor, that they only post the good things in their lives. And then I have other friends who only post the bad things in their lives. And it's a very interesting juxtaposition is like of how people use social media and what the goals are, what the end game is.

And we could probably do it entirely, just a separate podcast, just on social media, but I am wondering when we think about screen time and our overall personal well-being or life satisfaction, what's the connection there, and can it lead to diminishing those feelings? 

Dimitrios Tsatiris, MD: What you're presenting there is like two sides of the same coin, right? The one is like the negative, it can make you look at the world from like a negative lens, right? And the other one is like, look how great my life is, which again makes you feel negative about yourself, right?

So it's really two sides of the same coin. So because of all the sensory overload that we're exposed to, it can certainly play a role in decreased life satisfaction, right? Like, what's wrong with me? They seem to be happy. They seem to be doing great. Therefore, there's something inherently wrong with me, right?

The other thing about social media is that it takes us away from the present moment. You know, part of being present is just being in the here and the now, right? And enjoying what we have, you know, I'm looking out the window right now and hey, it's kind of sunny here in Northeast Ohio. We'll take it for once in February, you know. But when you're staring at a screen and you're looking at other people's lives, it takes you away from the present moment and that's very stressful and it can also be very depressing.

Host: Yeah, it really can, and I know, a big initiative or a big concern for schools, parents, you know, when we think about this comparison is also really about cyberbullying, which is a term that gets thrown around a lot, but it really happens a lot, whether it's through TikTok or Snapchat or whatever our kids are using.

So what are your thoughts about the screen time and our self-esteem and then, you know, what happens when we start comparing ourselves or our kids are comparing themselves or they're being bullied because they're not what, you know, Johnny is, so to speak. You know what I mean?

Dimitrios Tsatiris, MD: Yeah. As I answer that question, I remember when I was in high school, 25 years ago, and you know, teenagers can sometimes be mean, but the one good thing about that time was that when I was home, I was home, right? No one had access to me and I could just kind of be present with my family.

But now it's much harder for teenagers nowadays because with social media, we're more easily accessible. And that's again, a double edged sword. It can be beneficial if you're trying to access a friend and reach out to a friend, but you know, if there's a bully out there and you're a teenager in your home, well, now that bully can reach out to you via social media, right?

So cyberbullying is a very real phenomenon. And it comes at a significant cost to the mental health of children and teenagers because they care about identity. They care about what their peers think about them. Right? And it's different as an adult, you know, where our identities are a lot more engrained versus being a teenager or a kid where you really care about what other people think of you.

Right? So, one of the negatives of social media is that we've become more easily accessible and you can see how that can make cyber bullying a big problem for kids and teenagers.

Host: Yeah. And they all know where each other is because they share their location. And so they can look on Snapchat and see where people are. As you say, there used to be a way for us, Doctor, back in the day, you know, the old days, we could go somewhere and get away from school and stress and all of that, but now everybody seems to know where we are and what we're doing and what we're eating and all of that.

And as you say, a part of that, a component of that, could be cyberbullying. And I want to talk a little bit about with this technology, be it social media or otherwise, about how some of us and maybe even our teens are sort of escaping into it. Right? So they're dealing with emotional regulation and coping strategies and things like that, but they may be turning to their screens to just avoid things, right. To just avoid those negative emotions. How how can we sort of process that?

Dimitrios Tsatiris, MD: Yeah, you know, as human beings, we all have to cope with our realities, you know, and the question is whether we use healthy or unhealthy coping strategies. And, you know, a general rule of thumb, healthy strategies take a little more effort, a little more energy, right? Going for a walk, reading a book, right?

Whereas unhealthy coping strategies in general, they're easy. They don't take much effort, like going on our screens, right? The problem though is that the unhealthy coping strategies, they come with baggage. As we said before, too much screen time can come at a cost to our mental and physical and social health.

So it's like this vicious cycle that, hey, I'm not feeling well, I'm depressed or I'm anxious, or I'm even bored. And instead of doing something healthy about it, like, I don't know, reading a book, going for a walk, talking to a loved one, instead of that, we're just engaging in a strategy, screen time, which makes us more vulnerable to mental and physical health difficulties.

Host: Yeah, you know, when I was younger, Doctor, and I'd be in the car, I would listen to music. And if I was in a happy mood, I'd listen to happy music. And if I was having kind of a sad day or a blue day, I might listen to blues or something like that. And now I kind of do that with podcasts. As I program my day, I might listen to a more comedic podcast, the sort of the happy side or maybe true crime, you know, a little bit of the darker side.

And it makes me wonder, when we think about the types of content, the time of day, or maybe our own personality traits. Do you think that there's an impact, when we think about screen time, that could be influenced by some of these other things, the type of content? In other words, you know, am I gonna have a different type of day if I listen to a comedy podcast versus some dark true crime podcast? What are your thoughts on that?

Dimitrios Tsatiris, MD: Oh, absolutely, absolutely. You know, and as you described that, uh, example with like the music and the radio, that's it, that's a bonding experience by the way, right? Like you and maybe a parent or a sibling are in the car together, listening to music, maybe singing together, right? That's a bonding experience whereas screen time today seems a lot more isolating.

Like we're all on our phones individually or our tablets individually. So it's a different ballgame. As far as your question, a type of content plays a huge role, right? So it's important that we're mindful of what we're exposing ourselves to. It's one thing to like, you know, be reading an article for educational purposes versus, doom scrolling about how it's going to be the end of the world, right?

That's going to have a different impact on our mood and our perspectives. Right. Additional variables to consider are our age, right? You know, if you're a child, if you're a teenager, you're gonna be more susceptible to the negative effects of screen time because your brain is still developing and you still haven't figured out your identity versus an adult.

So I think that's something to consider. Also, if you're an introvert versus an extrovert, like what kind of personality traits you have. So in general, studies show that if you're an extrovert, you're more likely to be negatively impacted by screen time versus being an introvert. Because as an extrovert, you thrive off of face to face, in-person connections, right?

Another variable to consider is if you're a lighter sleeper or not, again, if you're a light sleeper, you really want to avoid screen time, like late at night. So the time of day plays a role as far as the potential impact. And then finally, if you're somebody who's prone to depression or anxiety, you want to be really careful when it comes to the use of screen time. Because again, it can be a risk factor for worse psychological well-being.

Host: So let's try to help folks, Doc. You know, we've sort of identified some of the problems and the effects, mental, physical, and otherwise. Well, let's talk some strategies or interventions to help mitigate the negative mental health effects.

Dimitrios Tsatiris, MD: So I think the first thing is knowledge. You can't make changes without knowledge and understanding that screen time can have both positive and negative effects. I don't want everybody like having a panic that, oh my goodness, screen time is like this horrible thing. Cause a lot of good things can come from internet and social media. But again, it can also have negative effects. So knowledge is number one. Number two, you want to be mindful before consuming screen time. Like before you reach for your phone, for example, press pause and ask yourself, how am I feeling?

And why am I reaching for my phone? Maybe you're reaching for your phone because you really need to look something up right now, or maybe you're reaching for your phone because you're bored. And if you're bored, are there other healthier ways to deal with a boredom? Like being creative or talking to a loved one, or maybe, I don't know, reading a book, right?

So take a moment to assess how you're feeling when you reach for a screen time. So I think those are a couple strategies, having the knowledge and also being mindful before reaching out for the screen.

Host: Yeah. That's a term that's come up a lot in different podcasts that I've done is just, uh, mindfulness, you know, being more mindful, being more present, and literally and figuratively. And as you say, we tend to turn to our phones out of boredom or escapism, whatever it might be. And one of the things I do, Doctor, sometimes is I sort of digitally detox, if you will, I try to say to myself, okay, I'm not going to use my phone from this time to this time.

Or when I wake up in the morning, the first thing I do is not going to be to check my phone and, you know, go on social media and check my email and all of that. I want to have you talk a little bit about that, the digital detoxes, if you will, or just taking regular breaks and do you recommend them? And if so, you know, what are the benefits? 

Dimitrios Tsatiris, MD: Yeah, I think it's important that we do that because we often reach for screens out of habit, automatically, like we do it without realizing that we're doing that, right? So in order to change our behaviors, we have to be intentional. And one way to be intentional is by saying, hey, I'm going to have a digital detox.

And it's a great way for us to help like press pause and just press reset and give the brain a rest from screen time, right? And the beautiful thing about digital detoxes too is that it also kind of helps you understand like, oh, wow, this is the impact that screen time is having on me. Like if you're doing a detox and you're having a really hard time and you're like craving to reach for your phone and you're struggling, like, Oh my God, it's been two hours and I'm having a hard time not reaching for my phone, then you know what that tells me is that like, you're really, I don't know, dependent on that phone, on that screen time, right? So I think that's valuable data when we do these exercises. So what I tell people is, hey, listen, if you're going to do a detox, that's fine. You know, start small, set realistic goals that are attainable and make sure that you have planned in advance, healthier alternatives.

So for example, if you like, want to not have screen time first thing in the morning when you wake up, well, what is the alternative behavior that you're going to do at that time? Like maybe you 15 minute mindfulness meditation instead of habitually looking at your phone, right?

So just make sure that you have a plan in place to replace the digital detox.

Host: Right. We, yeah, if we're going to digitally detox, we don't want to just maybe just sit there and stare off into space. Right. Let's make a productive use of that time. As you say, have a plan. I just want to finish up here. I know that some of my students use these different things to track their social media time, their screen time, all that kind of stuff on their phone.

So maybe you can talk about some of the tools or resources that can help us to monitor and manage and ultimately, and hopefully and ideally minimize the negative effects on our mental health.

Dimitrios Tsatiris, MD: Sure. Here's the one thing that I do. When I get home, the first thing that I do, you know, in the mudroom is I take off my wallet, my keys and my cell phone and I leave them there, you know, so that way when I'm home, I am present with my family and I've created some distance between me and my phone.

 Because even if you have your phone on silent, just having it in your pocket is a distraction. It just makes it easier you to go on your phone and be distracted. As far as some other tools, I would say that, you know, keep track of how much time you spend.

So like our smartphones, they have built in features to monitor screen time. So just have the data, like how much time do you spend a day with as far as screen time? Is it four hours, two hours, six hours? And how can you reduce it by even 10%? And what's that like? Right? Even if you're on social media, they have features that monitor your screen time and they set you a reminder when you've reached that designated limit. So for me, it's like 15 minutes and that's it. And that can be a powerful reminder to help you limit screen time and social media time.

Host: Yeah. And it can only help whether it's our kids, their parents, you know, I think about my daughter, as I mentioned, you know, 17, I suspect that she has her eyes on a screen virtually, you know, the entire day when she's awake. So when she's awake, she's staring at her phone and then she sleeps maybe for between six and eight hours.

And I know it's not healthy and I want to be a better parent as I know we all do. So I appreciate your time, your expertise today, a lot of food for thought. Thank you so much.

Dimitrios Tsatiris, MD: Oh, thank you for having me on the podcast.

Host: And for more information, go to summahealth.org/behavioral. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.